A rationally designed nuclei-targeting FAPI 04-based molecular probe with enhanced tumor uptake for PET/CT and fluorescence imaging.

PURPOSE: Fibroblast activation protein inhibitor (FAPI) -based probes have been widely studied in the diagnosis of various malignant tumors with positron emission tomography/computed tomography (PET/CT). However, current imaging studies of FAPI-based probes face challenges in rapid clearance rate and potential false-negative results. Furthermore, FAPI has been rarely explored in optical imaging. Considering this, further modifications are imperative to improve the properties of FAPI-based probes to address existing limitations and broaden their application scenarios. In this study, we rationally introduced methylene blue (MB) to FAPIs, thereby imparting nuclei-targeting and fluorescence imaging capabilities to the probes. Furthermore, we evaluated the added value of FAPI-based fluorescence imaging to traditional PET/CT, exploring the potential application of FAPI-based probes in intraoperative fluorescence imaging. METHODS: A new FAPI-based probe, namely NOTA-FAPI-MB, was designed for both PET/CT and fluorescence imaging by conjugation of MB. The targeting efficacy of the probe was evaluated on fibroblast activation protein (FAP)-transfected cell line and human primary cancer-associated fibroblasts (CAFs). Subsequently, PET/CT and fluorescence imaging were conducted on tumor-bearing mice. The tumor detection and boundary delineation were assessed by fluorescence imaging of tissues from hepatocellular carcinoma (HCC) patients. RESULTS: NOTA-FAPI-MB demonstrated exceptional targeting ability towards FAP-transfected cells and CAFs in comparison to NOTA-FAPI. This benefit arises from the cationic methylene blue (MB) affinity for anionic nucleic acids. PET/CT imaging of tumor-bearing mice revealed significantly higher tumor uptake of [18F]F-NOTA-FAPI-MB (standard uptake value of 2.20 ± 0.31) compared to [18F]F-FDG (standard uptake value of 1.66 ± 0.14). In vivo fluorescence imaging indicated prolonged retention at the tumor site, with retention lasting up to 24 h. In addition, the fluorescent probes enabled more precise lesion detection and tumor margin delineation than clinically used indocyanine green (ICG), achieving a 100.0% (6/6) tumor-positive rate for NOTA-FAPI-MB while 33.3% (2/6) for ICG. These findings highlighted the potential of NOTA-FAPI-MB in guiding intraoperative surgical procedures. CONCLUSIONS: The NOTA-FAPI-MB was successfully synthesized, in which FAPI and MB simultaneously contributed to the targeting effect. Notably, the nuclear delivery mechanism of the probes improved intracellular retention time and targeting efficacy, broadening the imaging time window for fluorescence imaging. In vivo PET/CT demonstrated favorable performance of NOTA-FAPI-MB compared to [18F]F-FDG. This study highlights the significance of fluorescence imaging as an adjunct technique to PET/CT. Furthermore, the encouraging results obtained from the imaging of human HCC tissues hold promise for the potential application of NOTA-FAPI-MB in intraoperative fluorescent surgery guidance within clinical settings.

Network Analysis of Borderline Personality Features in Adolescence Using a Screening Tool in a Chinese Community Sample.

INTRODUCTION: This study investigated the structure of the borderline personality features (BPFs) network and the most central BPF in adolescence. METHODS: Cross-sectional self-report data from 4,866 Chinese adolescents (M = 13.96, SD = 1.64; 61.3% girls) were included in the network analysis models. BPFs were assessed with the McLean Screening Instrument for Borderline Personality Disorder. RESULTS: Identity disturbance and affective instability emerged as the most central BPF in the current adolescent sample. In addition, chronic emptiness was also found with high centrality. The general networks of BPF were very similar between adolescent boys and girls, although some differences were detected. DISCUSSION: This study further supports the necessity of BPD assessment and diagnosis in adolescence and identifies the distinctive importance of identity and affective dysregulation in the early development of BPD. The findings provide empirical insights into the interconnections of BPF, which resonate with therapeutic mechanisms of evidence-based treatments for BPD. However, the research was limited in its use of a screening measurement rather than a diagnostic tool. Future studies can further explore BPD psychopathology in adolescence with longitudinal data and clinical interviews.

The Pathological Mechanism of Neuronal Autophagy-Lysosome Dysfunction After Ischemic Stroke.

The abnormal initiation of autophagy flux in neurons after ischemic stroke caused dysfunction of autophagy-lysosome, which not only led to autophagy flux blockage, but also resulted in autophagic death of neurons. However, the pathological mechanism of neuronal autophagy-lysosome dysfunction did not form a unified viewpoint until now. In this review, taking the autophagy lysosomal dysfunction of neurons as a starting point, we summarized the molecular mechanisms that led to neuronal autophagy lysosomal dysfunction after ischemic stroke, which would provide theoretical basis for the clinical treatment of ischemic stroke.

Decarboxylative N-Formylation of Amines with Glyoxylic Acid Promoted by H2O2.

A novel method for the synthesis of formamides through the decarboxylative N-formylation of amines with glyoxylic acid has been developed. This transformation provides an efficient protocol for the synthesis of various formamides with moderate to excellent yields, and it can accommodate a wide range of functional groups under metal free and base free conditions. In addition, the large-scale experiments and high chemoselectivity have shown great potential application of this strategy.

Preliminary psychometric properties of the Chinese version of the structured interview of personality organization (STIPO-CH).

BACKGROUND: Kernberg originally proposed the psychoanalytic concept of personality organization (PO), which measures personality pathology from a dimensional approach with multiple scales and can be evaluated using the Structured Interview of Personality Organization (STIPO) from six domains: identity, object relations, primitive defenses, coping vs. rigidity, aggression, and moral values. The present study translated the original version into the Chinese STIPO (STIPO-CH) version and evaluated its reliability and validity. METHODS: The STIPO-CH was administered to 49 non-clinical subjects. They also completed the Chinese version of the Inventory of Personality Organization and the Millon Clinical Multiaxial Inventory to evaluate criterion-related reliability. Interrater reliability was assessed with intraclass correlations. An item analysis was carried out to explore the structure and internal consistency. RESULTS: Interrater reliability (intraclass correlations) ranged from 0.98 to 0.99. Results suggested acceptable internal consistency for identity and moral values. The correlations between STIPO-CH domains and self-report questionnaires indicated that construct validity and criterion-related validity were acceptable to good. CONCLUSIONS: Overall, this study presents preliminary psychometric properties of STIPO-CH. Limitations regarding the sample, interviewers, and cultural differences are discussed. Future research is highly recommended.

DT-PICS: An Efficient and Cost-Effective SNP Selection Method for the Germplasm Identification of Arabidopsis.

Germplasm identification is essential for plant breeding and conservation. In this study, we developed a new method, DT-PICS, for efficient and cost-effective SNP selection in germplasm identification. The method, based on the decision tree concept, could efficiently select the most informative SNPs for germplasm identification by recursively partitioning the dataset based on their overall high PIC values, instead of considering individual SNP features. This method reduces redundancy in SNP selection and enhances the efficiency and automation of the selection process. DT-PICS demonstrated significant advantages in both the training and testing datasets and exhibited good performance on independent prediction, which validates its effectiveness. Thirteen simplified SNP sets were extracted from 749,636 SNPs in 1135 Arabidopsis varieties resequencing datasets, including a total of 769 DT-PICS SNPs, with an average of 59 SNPs per set. Each simplified SNP set could distinguish between the 1135 Arabidopsis varieties. Simulations demonstrated that using a combination of two simplified SNP sets for identification can effectively increase the fault tolerance in independent validation. In the testing dataset, two potentially mislabeled varieties (ICE169 and Star-8) were identified. For 68 same-named varieties, the identification process achieved 94.97% accuracy and only 30 shared markers on average; for 12 different-named varieties, the germplasm to be tested could be effectively distinguished from 1,134 other varieties while grouping extremely similar varieties (Col-0) together, reflecting their actual genetic relatedness. The results suggest that the DT-PICS provides an efficient and accurate approach to SNP selection in germplasm identification and management, offering strong support for future plant breeding and conservation efforts.

Development and psychometric properties of the Chinese Invalidating Family Scale.

The present study aims to develop the Chinese Invalidating Family Scale (CIFS) and examine its psychometric properties. The CIFS comprises two parts that measure the degree (Part 1) and types (Part 2) of family invalidation. Study 1 explored the structure and reliability of the CIFS using data from Sample 1 (N = 1323; Mage  = 26.3) and Sample 2 (N = 152; Mage  = 25.1). Part 1 of the CIFS is separated into father (20 items) and mother (27 items) subscales. Exploratory factor analysis identified four factors for the father subscale and five factors for the mother subscale. The shared factors are neglect, denial, emotional dysregulation, and overemphasis on achievements, while psychological control is the unique dimension for Mother subscale. Part 2 includes five items assessing the types of family environment. Results indicated acceptable to good reliability of the CIFS, with Cronbach's α higher than 0.60, split-half reliability higher than 0.70, ICCs higher than 0.70, and high criterion-related validity. Study 2 examined the structure and the validity of Part 1 with Sample 3 (N = 2282; Mage  = 19.90) through confirmatory factor analysis. Part 1 showed good construct validity (RMSEAs = 0.05, GFI, NFI, CFI, and AGFI >0.90) and acceptable convergent validity (AVE >0.36, CR >0.76). Overall, the CIFS is a promisingly stable and valid tool to evaluate the invalidating family environment in Chinese culture.

Effective identification of varieties by nucleotide polymorphisms and its application for essentially derived variety identification in rice.

BACKGROUND: Plant variety identification is the one most important of agricultural systems. Development of DNA marker profiles of released varieties to compare with candidate variety or future variety is required. However, strictly speaking, scientists did not use most existing variety identification techniques for "identification" but for "distinction of a limited number of cultivars," of which generalization ability always not be well estimated. Because many varieties have similar genetic backgrounds, even some essentially derived varieties (EDVs) are involved, which brings difficulties for identification and breeding progress. A fast, accurate variety identification method, which also has good performance on EDV determination, needs to be developed. RESULTS: In this study, with the strategy of "Divide and Conquer," a variety identification method Conditional Random Selection (CRS) method based on SNP of the whole genome of 3024 rice varieties was developed and be applied in essentially derived variety (EDV) identification of rice. CRS is a fast, efficient, and automated variety identification method. Meanwhile, in practical, with the optimal threshold of identity score searched in this study, the set of SNP (including 390 SNPs) showed optimal performance on EDV and non-EDV identification in two independent testing datasets. CONCLUSION: This approach first selected a minimal set of SNPs to discriminate non-EDVs in the 3000 Rice Genome Project, then united several simplified SNP sets to improve its generalization ability for EDV and non-EDV identification in testing datasets. The results suggested that the CRS method outperformed traditional feature selection methods. Furthermore, it provides a new way to screen out core SNP loci from the whole genome for DNA fingerprinting of crop varieties and be useful for crop breeding.

The "Visible" Muscles on Ultrasound Imaging Make Botulinum Toxin Injection More Precise: A Systematic Review.

BACKGROUND: Botulinum toxin (BoNT) injection is the most commonly performed procedure in cosmetic surgery. However, blind injection is unable to take individual anatomical variations into consideration, which is the main contributing factor to complications. Ultrasound (US) imaging was introduced to reduce complications and improve effects. This article will review uses of US in aesthetic BoNT injection. METHOD: A systematic electronic search was performed using the PubMed, MEDLINE, Web of science. Search terms were set to focus on aesthetic BoNT injection. Two independent reviewers subsequently reviewed the resultant articles based on strict inclusion and exclusion criteria. Selected manuscripts were analysed and grouped by procedure categories. Clinical cases were all performed by one plastic surgeon in our department. RESULTS: The search finally retained 24 articles. Five procedural categories were identified, including masseter (n = 16), frontalis (n = 2), glabella complex (n = 2), trapezius (n=1), and gastrocnemius (n = 3). US imaging is practical and instructive for pre-operative assessments as in needle-type selection, injection point localization and depth setting, as well as post-operative follow-ups regarding injection feedback (for instance, the extent of muscle volume decreases). What's more, ultrasound-guided injection makes needle trajectory visualized so as for the needle to reach the target muscle in avoidance of potential damage to neurovascular bundle, gland or adjacent muscle. CONCLUSION: Muscles, such as masseter, frontalis, glabella complex, trapezius and gastrocnemius, and their adjacent structures can be well visualized using US, and as such, US can be a useful tool for a variety of pre-operative, intra-operative and post-operative procedures. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Structural, elastic and electronic properties of atomically thin pyridyne: theoretical predictions.

In this paper, we propose a new acetylenic carbon material called pyridyne, which is composed of acetylenic linkages and pyridine rings. From first-principles calculations, we investigate the structural, elastic and electronic properties of pyridyne. It is found that the structure of pyridyne is stable at 300 K and its stability is comparable to experimentally synthesized graphdiyne and graphtetrayne. Compared with graphene or graphyne, pyridyne possesses more diverse pores and reduced delocalization of electrons. The in-plane stiffness of pyridyne is 183 N m-1 with a Poisson's ratio of 0.304. Pyridyne is found to be a semiconductor with a direct band gap of 0.91 eV. The intrinsic electron mobility can reach 6.08 × 104 cm2 V-1 s-1, while the hole mobility can reach 1.82 × 104 cm2 V-1 s-1.

Bilateral multiple periprosthetic hip fractures and joint dislocations secondary to general convulsive seizures.

BACKGROUND: During a seizure, there is a powerful and forceful contraction of muscles which may lead to fractures or joint dislocations. However, multiple periprosthetic hip fractures and joint dislocations secondary to seizures have not been reported. CASE PRESENTATION: A 49-year-old male developed spontaneous and bilateral multiple periprosthetic hip fractures and joint dislocations (including displaced fracture of the proximal right femur, avulsion fracture of the left lesser trochanter, left acetabular fracture and bilateral joint dislocations) secondary to generalized convulsive seizures which occurred within few hours after bilateral total hip arthroplasties (THAs). Bilateral open reconstruction and fixation were performed on the 21st day after primary THAs and on 2-year follow-up, the patient showed satisfactory functional outcome. CONCLUSIONS: Multiple periprosthetic hip fractures and joint dislocations secondary to seizure are extremely rare, and treatment targets for these injuries should focus on fracture healing and limb function recovery. Craniocerebral operation could bring an elevated risk of seizure; meanwhile, subsequent corticosteroid replacement threapy was complicated by secondary osteoporosis. Therefore, anti-osteoporotic and anti-epileptic therapy should be considered in this type of patients to avoid fracture and dislocation after arthroplasty.

[Yishen Tonglong Decoction inhibits the epithelial-mesenchymal transition and Ras/ERK signaling pathway in human prostate cancer DU-145 cells].

Objective: To observe the effect of Yishen Tonglong Decoction (YTD) on the epithelial-mesenchymal transition (EMT) and Ras/ERK signaling pathway in human PCa DU-145 cells and explore its action mechanism. METHODS: We treated human PCa DU-145 cells with normal plasma (the blank control) or plasma containing 5% (low-dose), 10% (medium-dose) and 15% (high-dose) YTD. After intervention, we examined the proliferation of the DU-145 cells in different groups with CCK-8 and their apoptosis by Annexin V/PI double staining. We detected the cell cycle by PI assay, the invasion and migration of the cells using the Transwell chamber and scratch test, and the expressions of the proteins and genes related to the EMT and Ras/ERK signaling pathways in the cells by Western blot and RT-PCR. RESULTS: Compared with the blank control group, high-, medium- and low-dose YTD significantly inhibited the proliferation of the PCa DU-145 cells, decreased their adherence and growth (P < 0.05, P < 0.01), promoted their apoptosis (P < 0.01), regulated their cell cycles (P < 0.05, P < 0.01), and reduced their in vitro invasion and migration abilities (P < 0.05), all in a dose-dependent manner. The results of Western blot and RT-PCR revealed down-regulated protein and mRNA expressions of N-cadherin, zinc finger transcription factor (Snail), Ras, p-ERK1/2 and ERK1/2, but up-regulated protein and mRNA expressions of E-cadherin in the PCa DU-145 cells treated with YTD (P < 0.05, P < 0.01). CONCLUSIONS: Yishen Tonglong Decoction can effectively inhibit the proliferation, promote the apoptosis, regulate the cell cycle and suppress the invasion and migration abilities and EMT process of human PCa DU-145 cells. The mechanism of Yishen Tonglong Decoction acting on PCa may be associated with its inhibitory effect on the EMT process and expression of the Ras/ERK signaling pathway in PCa cells./.

Cubic-like PtCuRu Nanocrystals with High Activity and Stability for Methanol Electro-oxidation.

Porous cubic-like PtCu and PtCuRu nanocrystals, which had a similar porous three-dimensional structure, were successfully prepared via the one-pot method. During the growth of the nanocrystals, cetyltrimethylammonium chloride and ascorbic acid were employed as the structure director and assistant reducing agent, respectively. The structure and possible formation of the nanocrystals were investigated. It is worth mentioning that the PtCuRu nanocrystals demonstrated a much better methanol electro-oxidation ability and ultrahigh stability, which displayed 3.4- and 3-fold higher specific and mass activity, respectively, than the commercial Pt/C. The advantage of PtCuRu nanocrystals was possibly ascribed to the synergistic effect of Cu and the porous structure and, more importantly, the presence of Ru that could more efficiently eliminate the harmful intermediates.

Prophylactic use of exogenous melatonin and melatonin receptor agonists to improve sleep and delirium in the intensive care units: a systematic review and meta-analysis of randomized controlled trials.

To investigate the efficacy of exogenous administration of melatonin and melatonin receptor agonists for the improvement of delirium, sleep, and other clinical outcomes of subjects in the intensive care unit (ICU). We carefully searched three electronic databases, i.e., Pubmed/Medline, Embase, and Cochrane library, to retrieve randomized controlled trials (RCTs) administrating melatonin or melatonin receptor agonists to adult subjects admitted to the ICU. Useful data such as the prevalence of delirium, duration of sleep, number of awakenings per night, duration of mechanical ventilation, and ICU stay as well as in-ICU mortality were extracted and pooled by using a random effect model. Eight RCTs were included in the qualitative analysis. Administration of exogenous melatonin and melatonin receptor agonists was associated with a trend towards elongated duration of sleep (pooled weighted mean difference/WMD = 0.43; 95% confidence intervals/CIs, - 0.02~0.88, p = 0.063) and could decrease the number of awakenings per night (pooled WMD = - 2.03; 95% CIs, - 3.83~- 0.22, p = 0.028). Meanwhile, participants in the treatment group showed a significantly reduced prevalence of delirium (pooled risk ratio/RR = 0.49; 95% CIs, 0.28~0.88, p = 0.017) and duration of ICU stay (pooled WMD = - 0.32; 95% CI, - 0.56~- 0.07, p = 0.002) in comparison with those in the control group. Exogenous administration of melatonin and melatonin receptor agonists could improve the sleep of subjects in the intensive care units, which may play an important role in decreasing the prevalence of delirium and shortening duration of ICU stay.

Radiological analysis of cystic lesion in osteonecrosis of the femoral head.

PURPOSE: Cystic lesions are a common complication in osteonecrosis of the femoral head (ONFH). This study will discuss the cause of cystic lesion formation and the feature of cystic lesion distribution in ONFH. According to the feature of cystic lesion in ONFH, we will discuss the possible mechanisms of cystic lesions and their  influence on collapse of the femoral head. MATERIALS AND METHODS: We retrospectively gathered 102 ONFH patients (168 hips) from November in 2015 to August in 2016 on China-Japan Friendship Hospital. Three categories of patients' medical information were collected: demographic characteristics, bone cystic lesion location, and pathological finding on CT and MRI imaging (microfracture, collapse, crescent sign). On mid-coronal and mid-axial CT section, the femoral head was divided into four quadrants for locating the cystic lesion. And we classified the location relationship of cystic lesion and sclerosis rim as G1 type, G2 type, and G3 type on coronal CT section. RESULTS: A significant difference was found between ONFH group with cystic lesion and ONFH group without cystic lesion in terms of microfracture (P < 0.001), collapse (P < 0.001), and crescent sign (P < 0.001). Forty-four cystic lesions (70%) are located in anterior hip area and 19 cystic lesions (30%) are located in posterior hip area. There were 14, 24, and seven cystic lesions (31, 53, 16%) locating in lateral, central, and medial pillars of the femoral head. G2 type was the most common pattern of location relationship between cystic lesion and sclerosis rim. CONCLUSION: Cystic lesions are often found near sclerosis rim in ONFH. The femoral head with osteonecrosis complicating by cystic lesions is more likely to accompany microfracture, collapse, and crescent sign which indicate structural instability in the femoral head. Cystic lesion in ONFH plays an important role in aggravating the progression of femoral head collapse. The peak stress from sclerosis rim may be a main factor inducing the formation of cystic lesion in ONFH via an OA-like mechanism.

The role of autophagy in steroid necrosis of the femoral head: a comprehensive research review.

Steroid-induced osteonecrosis of the femoral head (ONFH) has the incidence of 9-40% in patients receiving long-term treatment and is mainly involved in the middle and young people. It is mostly bilateral, with a wide range of necrosis and high disability rate, which brings disaster for patients and families. The experimental study shows that autophagy participates in the pathological process of steroid ONFH and is closely related to apoptosis, and the interaction between autophagy and bone cells is related to the dose of hormones. Moreover, autophagy also affects the interaction between osteoblasts and osteoclasts in ONFH. In the present review, we have discussed the role of autophagy in the pathological process of the steroid-induced ONFH.

Investigating clinical failure of core decompression with autologous bone marrow mononuclear cells grafting for the treatment of non-traumatic osteonecrosis of the femoral head.

OBJECTIVE: This study aimed to analyze the clinical factors related to the failure of autologous bone marrow mononuclear cells grafting (BMMCG) following core decompression (CD) in early stage osteonecrosis of the femoral head (ONFH). METHODS: In total, 148 patients (192 hips) underwent CD with autologous BMMCG for treatment of non-traumatic ONFH. The patients were classified by their ARCO staging and China-Japan Friendship Hospital (CJFH) typing system. All patients were clinically and radiographically followed up every three months during the first year and every six months in the following years. The clinical evaluation was conducted by pre- and post-operative Harris hip scores (HHS), while serial anteroposterior (AP) and frog lateral radiographs were used for post-operative radiographic evaluation. RESULTS: There were 56 hips as clinical failure cases, and 50 hips (89.29%) of failure cases developed between three and ten months after operation. Based on CJFH classification system, type L2 showed more failure rate with 60.0% (9 of15). The Cox risk model showed that disease type was an independent risk factor for post-operative clinical failure (P = 0.042). Multivariate analysis of the Cox proportional-hazards model showed that type L1 had a hazard ratio (HR) of 0.286 (95% CI 0.100-0.816), type L3 with HR of 0.245 (95% CI 0.079-0.759), respectively. CONCLUSION: Disease type is an important risk factor for autologous BMMCG combined with CD, and the degree of lateral pillar necrosis is a significant reference index for prognosis evaluation in early stage of ONFH.

A cis-regulatory map of the Drosophila genome.

Systematic annotation of gene regulatory elements is a major challenge in genome science. Direct mapping of chromatin modification marks and transcriptional factor binding sites genome-wide has successfully identified specific subtypes of regulatory elements. In Drosophila several pioneering studies have provided genome-wide identification of Polycomb response elements, chromatin states, transcription factor binding sites, RNA polymerase II regulation and insulator elements; however, comprehensive annotation of the regulatory genome remains a significant challenge. Here we describe results from the modENCODE cis-regulatory annotation project. We produced a map of the Drosophila melanogaster regulatory genome on the basis of more than 300 chromatin immunoprecipitation data sets for eight chromatin features, five histone deacetylases and thirty-eight site-specific transcription factors at different stages of development. Using these data we inferred more than 20,000 candidate regulatory elements and validated a subset of predictions for promoters, enhancers and insulators in vivo. We identified also nearly 2,000 genomic regions of dense transcription factor binding associated with chromatin activity and accessibility. We discovered hundreds of new transcription factor co-binding relationships and defined a transcription factor network with over 800 potential regulatory relationships.

Hip Osteonecrosis Is Associated with Increased Plasma IL-33 Level.

The recently discovered IL-33 as an IL-1 cytokine family member has been proved to be specifically released from osteonecrotic bones. We aimed to investigate the potential role of IL-33 in the development of osteonecrosis of femoral head (ONFH). Forty patients diagnosed with ONFH and forty age-, sex-, and body mass index- (BMI-) matched healthy subjects were included in this prospective study between March 2016 and September 2016. A commercially available ELISA kit was used to test the level of plasma IL-33. The IL-33 levels were compared among different ARCO stages, CJFH types, and etiology groups. Plasma IL-33 levels were significantly higher in the ONFH patients than that in the control subjects. The levels of IL-33 did not differ significantly among the ONFH patients with different ARCO stages. The IL-33 levels of patients with CJFH type L3 were significantly higher than that of patients with types L1 and L2. No significant differences were observed in IL-33 levels between steroid-induced, alcohol-induced, and idiopathic patients. Our findings seem to indicate that IL-33 effects may be detrimental during ONFH, which appeared to be associated with the prognosis of ONFH. The IL-33 deserves particular attention in the pathogenesis of ONFH.

Management of osteonecrosis of the femoral head with pedicled iliac bone flap transfer: A multicenter study of 2190 patients.

BACKGROUND: Osteonecrosis of the femoral head (ONFH) often affects young active adults and leads to destruction of the hip joint and disabling arthritis. Several procedures have been developed to arrest the progress of osteonecrosis and postpone the procedure of total hip replacement especially in young patients. The aim of this multicenter study was to analyze the results of the use of the vascularized iliac bone flap transfer for management of ONFH. METHODS: From January 1985 to December 2012, a total of 2190 patients (2690 hips) with the mean age of 43.15 years (ranging from 18 to 65 years) underwent hip-preserving surgery with the pedilced iliac bone flap transfer for management of ONFH with Ficat and Arlet stage II-IV in 8 hospitals. There were 1733 hips in stage II, 776 hips in stage III, and 181 hips in stage IV preoperatively. The complications were recorded. The outcomes were evaluated by radiograph, the Harris hip-scoring system (HHS). RESULTS: Postoperative complications occurred in 128 patients (5.84%). Among them, 25 patients had deep venous thromboses, 16 patients had sensory deficits, 40 patients had superficial infection and hematoma, and 47 patients had wound dehiscence. A total of 1912 patients (2179 hips) were followed up with a median time of 12 years (ranging from 5 to 25 years). There were 1787 hips with no radiographic osteonecrotic progress during follow-up, while osteonecrosis progress was observed in 186 hips with stage II (13.1%), 170 hips with stage III (25.6%) and 36 hips with stage IV (36.4%; P < .001). Two hundred fifteen hips (9.87%) in 203 patients were converted to THA during follow-up, including 19 hips with stage II (1.34%), 162 hips with stage III (24.4%), and 34 hips with stage IV (34.3%).The mean HHS at the end of follow-up was significantly improved when compared to preoperative mean HHS (83.63 ± 5.03 vs. 66.54 ± 6.05, P < .001). CONCLUSIONS: In this evaluation of a large series of cases, the vascularized iliac bone flap transfer showed good results for arresting the osteonecrosis progress and improving the hip function of patients with pre-collapse stages of ONFH.