Hepatic 31 P-magnetic resonance spectroscopy identified the impact of melatonin-pretreated mitochondria in acute liver ischaemia-reperfusion injury.

Acute liver ischaemia-reperfusion injury (IRI), commonly encountered during liver resection and transplantation surgery, is strongly associated with unfavourable clinical outcome. However, a prompt and accurate diagnosis and the treatment of this entity remain formidable challenges. This study tested the hypothesis that 31 P-magnetic resonance spectroscopy (31 P-MRS) findings could provide reliable living images to accurately identify the degree of acute liver IRI and melatonin-pretreated mitochondria was an innovative treatment for protecting the liver from IRI in rat. Adult male SD rats were categorized into group 1 (sham-operated control), group 2 (IRI only) and group 3 (IRI + melatonin [ie mitochondrial donor rat received intraperitoneal administration of melatonin] pretreated mitochondria [10 mg/per rat by portal vein]). By the end of study period at 72 hours, 31 P-MRS showed that, as compared with group 1, the hepatic levels of ATP and NADH were significantly lower in group 2 than in groups 1 and 3, and significantly lower in group 3 than in group 1. The liver protein expressions of mitochondrial-electron-transport-chain complexes and mitochondrial integrity exhibited an identical pattern to 31 P-MRS finding. The protein expressions of oxidative stress, inflammatory, cellular stress signalling and mitochondrial-damaged biomarkers displayed an opposite finding of 31 P-MRS, whereas the protein expressions of antioxidants were significantly progressively increased from groups 1 to 3. Microscopic findings showed that the fibrotic area/liver injury score and inflammatory and DNA-damaged biomarkers exhibited an identical pattern of cellular stress signalling. Melatonin-pretreated mitochondria effectively protected liver against IRI and 31 P-MRS was a reliable tool for measuring the mitochondrial/ATP consumption in living animals.

Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players.

PURPOSE: Only few studies have investigated medial epicondyle (MEC) lesions, particularly in the 12-18 age group. To the best of our knowledge, no study has compared ultrasonography (US), radiography and magnetic resonance imaging (MRI) in detecting MEC lesions. The aims of this study were to examine the value of US for detecting MEC lesions and to investigate correlations among diagnostic tools. METHODS: A prospective, comparative study was performed. Young baseball players from southern Taiwan were recruited, and basic characteristics, as well as passive range of motion (pROM) of the upper extremities, were recorded. Screening US was performed to identify MEC lesions, and players with MEC lesions received follow-up plain radiography and MRI. RESULTS: A total of 299 young baseball players were screened using US, and 28 of 299 players with possible MEC lesions were identified with a positive predictive value (PPV) of 88% according to MRI findings. The MEC lesions were primarily comprised of unfused ossicles and bony fragmentation. Other diagnoses, including UCL strain and medial epicondylitis, were also found by MRI in players with abnormal US screening results. The pROM of shoulder external rotation (ER) of the throwing hand was significantly reduced in players with MEC lesions (p = 0.006). CONCLUSIONS: Bony cortical discontinuity or fragmentation over the MEC warrants further research, and US provides good PPV for types of MEC lesions. Decreased shoulder ER may relate to MEC lesions and should be taken into consideration. The use of US may facilitate early detection and intervention. LEVEL OF EVIDENCE: IV, Cross-sectional study.

Effectiveness of ultrasonography screening and risk factor analysis of capitellar osteochondritis dissecans in adolescent baseball players.

BACKGROUND: Capitellar osteochondritis dissecans (COCD) is a common elbow injury in young baseball athletes. It may be asymptomatic at the early stage and may progress if left untreated. This study investigated the effectiveness of ultrasonography (US) screening for COCD in adolescent baseball players and identified risk factors of COCD. METHODS: A cross-sectional analysis study was conducted among baseball athletes aged 12 to 18 years. US screening of the throwing elbow was performed in all participants, and additional magnetic resonance imaging (MRI) was arranged for those with abnormal screening results. The prevalence of COCD was calculated according to MRI results. The US findings were compared with MRI findings. Data for characteristics, joint range of motion, and quality of pain were collected and analyzed using a logistic regression model to identify the risk factors of COCD. RESULTS: A total of 299 adolescent baseball players were screened, and 17 were found to have COCD according to US findings. MRI was performed in 15 of these 17 players, and the MRI findings further confirmed COCD in 10 players (66.7%). The presence of elbow pain while at rest, body height, and age at introduction to baseball were predictors of COCD. CONCLUSIONS: Although the effectiveness of diagnosing stage 1 COCD is satisfactory, US is a helpful tool for detecting stage 2 and higher-stage COCD. Elbow resting pain, lower body height, and introduction to baseball at a younger age are risk factors for COCD.

Evaluating posterior cruciate ligament injury by using two-dimensional ultrasonography and sonoelastography.

PURPOSE: This study aimed to elucidate the diagnostic criteria for posterior cruciate ligament (PCL) injury using ultrasonography. METHODS: Thirty-three patients with clinically suspected PCL injuries and 30 normal control subjects were recruited. Both groups were assessed using sonographic examination with reliability testing. Patients also underwent posterior stress radiography and magnetic resonance imaging (MRI). PCL thickness on two-dimensional ultrasonography (2D US), pixel intensity on sonoelastography, displacement on posterior stress view, and severity grading using MRI were analysed. Receiver operating characteristic (ROC) curves were plotted using MRI as the gold standard. Correlation coefficients among variables were calculated. RESULTS: Good to excellent reliabilities were noted for 2D US and red pixel intensity on sonoelastography. In injured knees, PCL thicknesses were significantly greater, and red pixel intensities were significantly lower, compared to non-injured knees of patients and healthy controls. This indicates increased swelling and softness in injured PCLs. The area under the PCL thickness ROC curve was 0.917 (p < 0.001), and the best diagnostic criterion was a thickness ≥6.5 mm (90.6 % sensitivity and 86.7 % specificity). Thickness correlated with red pixel intensity, International Knee Documentation Committee examination grade, and MRI severity grading. In addition, effusions were detected on 2D US in all knees with "tears" of other structures on MRI. CONCLUSIONS: 2D US is a useful tool to diagnose PCL injury, and PCL thickness ≥6.5 mm is the recommended diagnostic criterion. LEVEL OF EVIDENCE: II.

The Efficacy of Combined Use of Rivaroxaban and Tranexamic Acid on Blood Conservation in Minimally Invasive Total Knee Arthroplasty a Double-Blind Randomized, Controlled Trial.

BACKGROUND: Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA. METHODS: In a prospective, randomized, controlled trial, 198 patients were assigned to placebo (98 patients, normal saline injection) and study group (100 patients, 1g TXA intraoperative injection) during primary unilateral minimally invasive TKA. All patients received rivaroxaban 10 mg each day for 14 doses postoperatively. Total blood loss was calculated from the maximum hemoglobin drop after surgery plus amount of transfusion. The transfusion rate and wound complications were recorded in all patients. Deep-vein thrombosis was detected by ascending venography of the leg 15 days postoperatively. RESULTS: The mean total blood loss was lower in the study group (1020 mL [95% confidence interval, 960-1080 mL]) compared with placebo (1202 mL [95% confidence interval, 1137-1268 mL]) (P < .001). The transfusion rate was lower in the study group compared with placebo (1% vs 8.2%, P = .018). Postoperative wound hematoma and ecchymosis were higher in placebo than the study group (P = .003). There was no symptomatic deep-vein thrombosis or pulmonary embolism in either group. CONCLUSION: Systemic administration of TXA can effectively reduce the postoperative blood loss which results in lower rate of transfusion requirement and wound hematoma in minimally invasive TKA patients when rivaroxaban is used for thromboprophylaxis. Rivaroxaban has a high rate of bleeding complications when used alone in TKA patients.

Shockwave therapy improves anterior cruciate ligament reconstruction.

BACKGROUND: Shockwave was shown to enhance the healing of anterior cruciate ligament (ACL) reconstruction in rabbits. This study evaluated the effect of extracorporeal shockwave therapy (ESWT) on ACL reconstruction in human subjects. We hypothesized that ESWT may improve human ACL reconstruction. METHODS: Fifty-three patients were randomized into two groups with 26 patients in ESWT group and 27 patients in control group. The ESWT group underwent single-bundle hamstring autograft ACL reconstruction and received ESWT immediately after surgery. The control group underwent ACL surgery without ESWT. Both groups received the same rehabilitation postoperatively. The evaluations included Lysholm score, IKDC score and KT-1000, radiograph, bone mineral density, and magnetic resonance imaging. RESULTS: ESWT group showed significantly better Lysholm score than control group at 1 and 2 y postoperatively (P < 0.001 and 0.001, respectively). No significant difference was noted in IKDC score between the two groups (P = 0.080 and 0.076, respectively). The KT-1000 values were significantly better in ESWT group than control group at 2 y postoperatively (P = 0.027). The tibia tunnel on X-ray was significantly smaller in ESWT group compared with control group at 2 y (P = 0.018). The bone mineral density values showed no discernable difference between the two groups at 6 mo and 2 y (P = 0.522 and 0.984, respectively). On magnetic resonance imaging, ESWT group showed significant decrease in tibia tunnel enlargement at 6 mo and 2 y compared with the control group (P = 0.024 and <0.001, respectively). CONCLUSIONS: ESWT significantly improves the subjective Lysholm score and decreases the middle 1/3 tibia tunnel enlargement after single hamstring autograft ACL reconstruction.

Short-term clinical outcomes of transarterial embolization for symptomatic hand osteoarthritis refractory to conservative treatment.

PURPOSE: The present study aims to assess the short-term clinical outcomes and safety of transarterial embolization (TAE) for symptomatic hand osteoarthritis (OA) refractory to conservative treatment. METHODS: The present retrospective cohort pilot study included nine patients who underwent TAE for symptomatic OA-associated hand pain in a single tertiary center between November 2022 and January 2023. The baseline and post-procedural OA-associated hand pain and function were assessed using the visual analog scale (VAS) and the Australian Canadian Hand Osteoarthritis Index (AUSCAN). The use of conservative treatment and pain medications was also recorded. Post-procedural adverse events were evaluated according to the Society of Interventional Radiology classification. RESULTS: Compared with the baseline, the overall VAS scores were significantly decreased at 1-week, 1-month, 3-months, and 6-months after TAE (76 ± 15 mm versus 34 ± 18 mm, P < 0.001; 32 ± 11 mm, P < 0.001; 21 ± 15 mm, P < 0.001; 18 ± 19 mm, P = 0.002). Similarly, improvement in the mean total AUSCAN scores (22.0 ± 10.0 versus 13.2 ± 6.6, P = 0.007; 14.11 ± 7.3, P = 0.004; 9.8 ± 6.8, P = 0.004; 9.3 ± 7.4, P = 0.011) were documented. The use of other conservative treatment methods also gradually decreased. There were no severe adverse events reported during the follow-up period. CONCLUSION: TAE is a feasible and safe treatment method for symptomatic hand OA refractory to conservative treatment. This minimally invasive procedure effectively relieves debilitating OA-associated joint pain and restores hand function with a durable treatment effect.

Psoas muscle area as a predictor of low muscle mass in Asian patients with compensated advanced chronic liver disease.

PURPOSE: The relationship between the psoas muscle index (PMI) and the appendicular skeletal muscle index (ASMI) in patients with compensated advanced chronic liver disease (cACLD) is not yet understood. Our goal is to determine which level of the lumbar spine best represents the appendicular skeletal muscle. METHODS AND MATERIALS: This retrospective study involved patients with cACLD between January 2020 and December 2021. We documented the patients' body weight, height, gait speed, handgrip strength, appendicular skeletal muscle measured by DXA, and psoas muscle area segmented on computed tomography or magnetic resonance imaging. Low muscle mass, as defined by the Asian working group for sarcopenia, is less than 7.0 kg/m2 in males and less than 5.4 kg/m2 in females. We analyzed the correlation between PMI and ASMI. RESULTS: A total of 134 patients were enrolled in the study, with 74 being male and 60 being female. The mean age was 63.9 ± 7.7 years old. Significant associations (p < 0.001) were found between PMI of all levels and ASMI. In the analysis of Pearson's correlation coefficients, it was noted that the r value increased gradually in both males (r = 0.3197 at L2, 0.4006 at L3, 0.5769 at L4) and females (r = 0.3771 at L2, 0.4557 at L3, 0.5251 at L4). Similarly, the area under the curve (AUC) values predicting low muscle mass were as follows: for males, AUC=0.582 at L2, 0.619 at L3, 0.728 at L4; for females, AUC=0.685 at L2, 0.733 at L3, 0.744 at L4. The cut-off point for PMI in males was 4.12 at L2, 6.25 at L3, and 8.48 at L4, while in females was 2.61 at L2, 4.47 at L3, 6.07 at L4. CONCLUSION: The Psoas muscle index can be used to assess the muscle mass status in patients with cACLD. Among the various levels that can be used, we recommend using the fourth inferior endplate of the lumbar spine, as it shows the highest correlation. Additionally, we suggest using a PMI cut-off point of 8.48 cm2/m2 for males and 6.07 cm2/m2 for females as a predictor of low muscle mass in Asian.

Interplay between fat, muscle, bone mass, and oteophytes and risk for tophaceous gout.

Tophaceous gout is a common arthritis caused by the deposition of urate crystals and is related to limited joint function. Although there are reports that uric acid (UA) is associated with bone mineral density (BMD), little is known about the relationship between UA, osteophytes, and muscle. This cross-sectional case-control study was performed in patients with tophaceous gout. The control group included patients without gout. All subjects underwent BMD and body composition analyses. Age, sex, alcohol consumption, smoking, and radiography of both knees were recorded. Adjusted ORs for tophaceous gout were calculated using the logistical regression models. A total of 150 male patients were enrolled, including 65 individuals with tophaceous gout and 85 without gout. The mean age of the patients with tophaceous gout was 59.94±12.40 years, while that of individuals without gout was 61.29±11.57 years (p=0.492). Patients with tophaceous gout have a higher mean body mass index, fat mass, appendicular lean mass, BMD, and osteophytes. Multiple logistic regression analysis revealed that fat mass (OR 2.01, 95% CI 1.27 to 3.18), appendicular lean mass (OR 4.27, 95% CI 1.86 to 9.83), and osteophytes (OR 5.88, 95% CI 1.72 to 20.13) were significantly associated with tophaceous gout. In the current study, higher fat mass, high muscle mass, and osteophyte formation were found to increase the risk of tophaceous gout, as the association is the most than can be inferred from a cross-sectional study. Therefore, reducing body fat and weight management may prevent tophaceous gout.

Association of a femoral neck T score with knee joint osteophyte formation but not with skeletal muscle mass.

BACKGROUND: Osteophyte formation is an important radiographic sign of osteoarthritis (OA) and limited joint motion in knee osteoarthritis patients. Some studies revealed relationships of osteophyte formation with a high bone mineral density and a high muscle mass, while others showed no correlations. The aim of this study was to identify relationships of osteophyte formation with bone mineral density and muscle mass. METHODS: A cross sectional study of knee osteoarthritis was conducted. Cases were classified as patients with osteophyte formation, while controls were those without osteophytes. All subjects underwent a knee x-ray and bone mineral density and body composition evaluation. General patient characteristics, covariates, and the results of biochemical analyses were also recorded. Statistical analysis was conducted using SPSS Version 22.0. Logistic regression and the chi-square test were utilized to analyze the relationships between the presence of knee osteophytes and the study variables. RESULTS: A total of 228 patients were enrolled, including 78 with osteophytes in the knee joint and 150 without. A total of 162/228 are females; knee OA is commonly explained among females. (p = 0.001). The mean age was 73.23 ± 11.10 years in the osteophyte group and 71.86 ± 12.23 in the no osteophyte group (p = 0.409). The mean body mass index was 24.15 ± 3.27 kg/m2 in the osteophyte group and 23.37 ± 3.48 kg/m2 in the no osteophyte group (p = 0.433). More patients in the osteophyte group had hypertension (p = 0.002), so the age group 73 years expected to have OA and hypertension along other metabolic diseases, and the femoral neck T score was higher in the osteophyte group (p = 0.044). Logistic regression analysis showed that the male gender was associated with less osteophyte formation (p = 0.001, odds ratio (OR) 0.11 (0.03-0.37)), and hypertension was associated with increased muscle loss (p = 0.005). Femoral neck T score was associated with the presence of osteophyte formation (p = 0.011, OR 1.98 (1.17-3.36)). CONCLUSIONS: The results demonstrated an association of knee osteophyte formation with the femoral neck T score and hypertension, but no association with muscle mass. We speculated that in patients with osteophytosis and increased bone mass, metabolic factors such as hypertension should be considered. Further study of the molecular mechanisms regulating these processes is needed in the future. Key Points • Associations of knee osteophyte formation with the femoral neck T score, but not with muscle mass. • Those with osteophytosis and an increased bone mass and metabolic factors such as hypertension need to be assessed.

Factors associated with osteoarthritis in menopausal women: A registry study of osteoporosis sarcopenia and osteoarthritis.

Background: Bone and muscle mass decline after menopause. The risk of osteoarthritis (OA), sarcopenia, and osteoporosis increases in later life. Our objective aimed to assess the possible factors affecting osteoarthritis in menopausal women. Methods: This is a registry study of osteoporosis, sarcopenia, and osteoarthritis. All subjects accepted bone mineral density (BMD) and body composition studies, and X-rays of both knees were performed. A medical history was taken and biochemical data were recorded. Logistic regression analyses were used to examine the associations between the presence of osteoarthritis and BMD, muscle mass, and other parameters. Results: A total of 139 patients were enrolled. The mean age of the patients was 73.86 ± 5.83 years in the osteoarthritis group and 74.53 ± 9.90 in the non-osteoarthritis group (p = 0.663). The mean body mass index (BMI) was 24.36 ± 3.64 kg/m2 in the osteoarthritis group, compared with 23.78 ± 3.61 in the non-osteoarthritis group (p = 0.366). The lumbar spine T score was -2.06 ± 1.33 g/cm2 in the osteoarthritis group, and -1.25 ± 1.76 in the non-osteoarthritis group (p = 0.006). There were no significant differences in smoking, alcohol consumption, diabetes, hypertension, cardiovascular disease, neurological disease, and chronic kidney disease between the two groups. When we used osteoarthritis as the outcome, we found that the lumbar spine T score had a significant association with osteoarthritis, with a high T score associated with less osteoarthritis formation (p = 0.024, odds ratio (95% confidence interval) 0.06 (0-0.69)). Conclusions: Knee osteoarthritis was associated with lumbar spine bone density. This study provides the initial information required to develop clinical algorithms for the early identification of potential high-risk populations, as well as essential information for the development of policies for the detection and prevention of osteoarthritis in menopausal women.

TRICKS magnetic resonance angiography at 3-tesla for assessing whole lower extremity vascular tree in patients with high-grade critical limb ischemia: DSA and TASC II guidelines correlations.

The entire vascular tree of 58 lower extremities with high-grade critical limb ischemia (CLI) was assessed with three-station time resolved imaging of contrast kinetics (TRICKS) magnetic resonance angiography (T-MRA) and correlated with digital subtraction angiography (DSA) examinations and Trans-Atlantic Inter-Society Consensus II (TASC II) guidelines. Kappa (κ) statistics were utilized to evaluate the agreement of stenosis scores (5-point scale; 0 normal to 4 occlusion) based on T-MRA and DSA. With DSA as the standard, significant stenosis instances (stenosis score ≥2) among vascular segments were compared. The κ-statistics of image quality (4-point scale; 1 nondiagnostic to 4 excellent) of T-MRA and TASC II classification assessed by a radiologist and a vascular surgeon were also evaluated. Among 870 vascular segments, excellent agreement was observed between T-MRA and DSA (mean κ = 0.883) in revealing stenosis (mean stenosis score, 2.1 ± 1.3 versus 2.0 ± 1.3). T-MRA harbored overall high sensitivity (99.5%), specificity (93.6%), positive predictive value (95.4%), negative predictive value (99.6%), and accuracy (97.7%) in depicting significant stenosis. Excellent interobserver agreement (mean κ = 0.818) of superb image quality (mean score = 3.5-3.6) of T-MRA and outstanding agreement of TASC II classification of aortoiliac and femoral-popliteal lesions (κ = 0.912-0.917) between two raters further verified the clinical feasibility of T-MRA for treatment planning.

Phlebosclerotic colitis: an analysis of clinical and CT findings in 29 patients with long-term follow-up.

BACKGROUND: Phlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia. This retrospective study analyzed the clinical findings and temporal CT changes in 29 PC patients with long-term follow-up. METHODS: Twenty-nine patients with characteristic CT features of PC collected between 1997 and 2020 were stratified into the acute abdomen group (AA-group) (n = 10), chronic-progressive group (CP-group) (n = 14) and chronic-stable group (CS-group) (n = 5). Clinical and CT changes during follow-up, comorbidities and final outcomes were compared. RESULTS: The AA-group exhibited a significantly thicker colonic wall and more involved segments and pericolic inflammation than the CP-group and CS-group on initial CT (p = < 0.001-0.031). Seven patients in the AA-group who underwent right hemicolectomy had no recurrence during follow-up (mean ± SD, 7.1 ± 3.3 years), and the remaining three patients with renal or hepatic comorbidities who underwent conservative treatment died within 14 days. The CP-group showed significantly higher frequencies of chronic renal failure, urinary tract malignancies and liver cirrhosis than the AA-group (p = 0.005-0.008). In addition, CT follow-up (7.9 ± 4.3 years) showed significant increases in mesenteric venous calcifications, colonic wall thickening and involved colonic segments (p = 0.001-0.008) but conservative treatments were effective. The CS-group remained unchanged for years (8.2 ± 3.9 years). CONCLUSIONS: Early surgery offered excellent prognosis in PC-related acute abdomen denoted by marked right colonic wall thickening and pericolic inflammation on CT. Conservative treatments with a wait-and-watch strategy were appropriate for CP-PC and CS-PC, albeit CP-PC harbored significant increases in calcifications, colonic wall thickening and affected segments in long-term CT follow-up.

Use of proteomic differential displays to assess functional discrepancies and adjustments of human bone marrow- and Wharton jelly-derived mesenchymal stem cells.

Mesenchymal stem cells (MSCs) from bone marrow are suitable for the reconstruction of connective tissues and even brain tissue but have limitations in terms of cell expansion and fully specific differentiation. In our current study, we have attempted to adjust and improve the cell expansion and differentiation properties of human MSCs from different tissues. MSCs from normal bone marrow and Wharton jelly were subjected to proteomic differential displays, followed by functional adjustments based on these displays. Bone marrow MSCs expressed more transgelin-2 and differentiated more rapidly into bone nodules but showed a slower growth rate. A knockdown of transgelin-2 expression by specific small interfering RNA (siRNA) significantly increased the growth rate of these cells, the G1/S phase cell cycle transition, and the interaction of cyclin D1 with cdk2. Wharton jelly MSCs expressed the chaperone protein HSP90ß at higher levels and differentiated slowly toward an osteogenic lineage. However, the knockdown of HSP90ß expression significantly increased bone nodule formation, inhibited cell growth, decreased the number of cells in the G1/S phase of the cell cycle, and decreased the interaction of cyclin D1 with cdk2 and of cyclin E with cdk2. These results were validated by the in vivo repair of segmental bone defects in a mouse model with severe combined immunodeficiency. We thus demonstrate an improvement in the cell expansion and tissue regeneration properties of human MSCs through specific adjustments.

The effects of shockwave on systemic concentrations of nitric oxide level, angiogenesis and osteogenesis factors in hip necrosis.

This study investigated the effects of shockwave on systemic concentrations of nitric oxide (NO) level, angiogenic and osteogenic and anti-inflammatory factors in hips with osteonecrosis of the femoral head (ONFH). Thirty-five patients (47 hips) with ONFH were enrolled in this study. Each hip was treated with 6,000 impulses of shockwave at 28 kV in a single session. Ten milliliters of peripheral blood was obtained for the measurements of serum NO level, angiogenic factors (VEGF, vWF, FGF basic and TGF-ß1); osteogenic factors (BMP-2, osteocalcin, alkaline phosphatase, DKK-1 and IGF); and anti-inflammation markers (sICAM and sVCAM) before treatment and at 1, 3, 6 and 12 months after treatment. The hips were evaluated with clinical assessment, serial radiograph and MRI. At 12 months, the overall results showed 83% improved and 17% un-improved. Total hip was performed in 4 cases (8.5%). Serum NO3 level showed significant elevation at 1 month after treatment, but the changes at 3, 6 and 12 months were not significant. For angiogenesis, significant elevations of VEGF, vWF and FGF basic and a decrease in TGF-ß1 were observed at 1 month, but the changes at 3, 6 and 12 months were non-significant. For osteogenesis, BMP-2, osteocalcin, alkaline phosphatase and IGF were significantly elevated, while DKK-1 was decreased at 1 month, but the changes at 3, 6 and 12 months were not significant. For anti-inflammation markers, significant decreases in sICAM and sVCAM were noted at 1 month after treatment, but the changes at 3, 6 and 12 months were non-significant. Local ESWT application results in significant elevations of serum NO level, angiogenic and osteogenic and anti-inflammatory factors in ONFH.

Epidermal cysts in the superficial soft tissue: sonographic features with an emphasis on the pseudotestis pattern.

OBJECTIVES: The purposes of this study were to report the sonographic features of superficial epidermal cysts with an emphasis on the characteristic pseudotestis appearance and to highlight the spectrum of ancillary findings. METHODS: The medical records and sonographic studies of all cases of surgically proven epidermal cysts (n = 42) from January 2005 through December 2009 were reviewed. Twenty-six epidermal cysts (62%) that appeared on sonography as ovoid nodules with homogeneous low to medium echoes, simulating a testicle, were included in the pseudotestis group. The other 16 epidermal cysts (38%) without the pseudotestis pattern were included in the nonpseudotestis group. The age, sex, lesion size, length to width ratio, sonographic appearances, and frequencies of rupture and infection were compared between the groups. RESULTS: Epidermal cysts in the nonpseudotestis group presented as heterogeneously echoic or lobulated nodules or had a concentric ring or target appearance. There were no significant differences in the age, sex, lesion size, and length to width ratio between the groups. The pseudotestis group had significantly higher frequencies of intralesional bright echogenic reflectors and filiform anechoic areas than the nonpseudotestis group (P < .01). There were no significant differences in the associated ancillary sonographic features, including posterior acoustic enhancement, dermal attachment, focal dermal protrusion, and frequencies of rupture and infection between the groups. CONCLUSIONS: In this study, two-thirds of the superficial epidermal cysts had a characteristic pseudotestis pattern on sonography, whereas the others could be suspected by recognition of the ancillary sonographic findings, including dermal attachment and focal dermal protrusion or a distinctive concentric ring or target pattern.

Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study.

HYPOTHESIS: A randomized, double-blind, placebo-controlled study of sodium hyaluronate (ARTZ Dispo) treatment was performed in 51 patients with rotator cuff lesions without complete tears. We hypothesized that ARTZ Dispo would render better results than the placebo. MATERIALS AND METHODS: Twenty-five patients (ARTZ Dispo group) had injections of 25 mg/wk of sodium hyaluronate into the subacromial bursa for 5 consecutive weeks. Twenty-six patients (placebo group) were given 2.5 mL of normal saline solution with the same injection protocol as the ARTZ Dispo group. No significant difference in age, height, weight, gender, vocation, involved shoulder, duration of symptoms, baseline Constant score, or visual analog scale (VAS) score existed between the 2 groups. RESULTS: The 2 groups did not significantly differ with regard to Constant scores, VAS scores, or global improvement assessments 1 week after injections. The ARTZ Dispo group had a better Constant score (P = .0095) and VAS score (P = .0018) than the placebo group 6 weeks after treatment. Patients in the placebo group were given 5 sodium hyaluronate injections, rather than placebo, after disclosure of the blind list, if they wished. Forty-one patients who underwent hyaluronate injection exhibited a significantly improved Constant score, from 64.0 +/- 11.7 at baseline to 88.9 +/- 10.4 (P < .0001), and a significantly improved VAS score, from 6.4 +/- 1.3 to 1.5 +/- 1.6 (P < .0001), at a mean follow-up of 33.1 months. No significant adverse effect was noted. CONCLUSIONS: Subacromial injections of sodium hyaluronate are effective in treating rotator cuff lesions without complete tears.

Cocktail therapy for femoral head necrosis of the hip.

INTRODUCTION: Cocktail therapy consists of extracorporeal shock wave treatment (ESWT), hyperbaric oxygen therapy (HBO) and alendronate. We hypothesized that this combined therapy may produce better results than ESWT alone when treating hip necrosis. METHODS: This prospective, randomized study evaluated the effectiveness of cocktail therapy in early hip necrosis, and then compared it to shock wave treatment alone. Sixty-three patients (98 hips) were randomly divided into two groups. Group A consisted of 28 patients (50 hips) who received cocktail therapy, and group B consisted of 35 patients (48 hips) who received only ESWT. Each affected hip was treated with 6,000 shocks of ESWT at 28 kV (equivalent to 0.62 mJ/mm2) in a single session. Cocktail patients also received HBO therapy performed in a multi-place chamber daily for 20 treatments, and they were administered 70 mg of alendronate orally per week for 1 year. The evaluations included clinical assessment, radiograph and MRI. RESULTS: After a minimum of 2-years of follow-up, the overall results showed 74% improved, 16% unchanged and 10% worsened in group A; and 79.2% improved, 10.4% unchanged and 10.4% worsened in group B (P = 0.717). Total hip replacement (THR) was performed for 10% of group A and 10.4% of group B (P = 0.946). MRI showed significant reduction in bone marrow edema and a trend of decrease in the size of the lesions in both groups, however, no difference was noted between the two groups. Cocktail therapy is effective for early hip necrosis, but the results are comparable to ESWT in short-term follow up. The joint effects of HBO and alendronate over EWST were not observed. CONCLUSION: Long-term results are needed to determine whether or not the synergistic effects of ESWT, HBO and alendronate over ESWT alone exist in early hip necrosis.

Broken-crescent sign at CT indicates impending aortic rupture in patients with acute aortic intramural hematoma.

BACKGROUND: This retrospective study evaluated the computed tomography (CT) features and clinical implications of a novel broken-crescent sign in patients with acute aortic intramural hematoma (IMH). METHODS: Out of 104 patients with aortic IMH encountered in our institution between 2003 and 2018, nine patients exhibited a positive broken-crescent sign, which was defined as a focal defect within the hyper-attenuating crescentic IMH on unenhanced CT, corresponding to a smooth out-bulging of the aortic lumen on enhanced study. The clinical findings, CT features, and outcomes of these nine patients were analyzed. RESULTS: Of five males and four females (age range 48-84 years, mean 69.7 years), six had type A and three had type B IMH. Five patients who had medical treatment and stable status for 1 to 3 days suffered sudden death, two of whom showed ascending aortic rupture with hemopericardium in one and adventitial tear with outward spillage of IMH in another at follow-up CT. The other four patients had early surgical or endovascular management survived; two demonstrated ascending aorta ecchymosis with adventitial tear and intact intima at surgery. Our results support the supposition that aortic IMH complicated with adventitial tear and partial outward seepage of IMH may generate a broken-crescent sign in CT. Despite initially stable clinical status, the residual intact inner aortic wall carries a high risk of sudden aortic rupture. CONCLUSIONS: In patients with acute aortic IMH, identification of a broken-crescent sign in CT is highly suggestive of impending aortic rupture, and early aggressive treatment is mandatory.

The Therapeutic Effects of Extracorporeal Shock Wave Therapy (ESWT) on the Rotator Cuff Lesions with Shoulder Stiffness: A Prospective Randomized Study.

Aim: We wish to investigate the therapeutic potential of a single-session high-energy extracorporeal shock wave therapy (ESWT) on the rotator cuff lesions with shoulder stiffness. Patients and Methods. Thirty-seven patients afflicted with rotator cuff lesions with shoulder stiffness were randomized to receive either shockwave or sham treatment based on statistical randomization. In the shockwave group, we used Orthospec™ Extracorporeal Shock Wave Therapy 3000 impulse 24 kV (0.32 mJ/mm2) focused at two points as one session. The sham intervention entailed the use of the device in which the silicone pad was removed from the stand-off device. The visual analogue scale (VAS), muscle power of the shoulder, Constant and Murley score (CMS), and range of motion (ROM) of the shoulder were assessed for all patients. Ten milliliters of peripheral venous blood was obtained from every participant for the measurements of markers for inflammation, tissue regeneration, angiogenesis, and substance P before and at 1 week and 4 weeks after intervention. Results: The ESWT group has significantly better VAS, muscle power, CMS, and ROM at 6 and 12 months after intervention. No between-group differences were observed before as well as 1 and 4 weeks after intervention in the selected biomarkers. Conclusion: ESWT may be a good adjuvant for the treatment of rotator cuff lesions with shoulder stiffness.