Clinical features and prognosis of multiple myeloma and orbital extramedullary disease: Seven cases report and review of literature.

BACKGROUND: Multiple myeloma (MM) complicated with extramedullary disease (EMD) has a poor prognosis and is a limiting factor in the treatment of MM, and no standard treatment is recommended in international guidelines. Few studies have reported MM with periorbital EMD. CASE SUMMARY: In this paper, the clinical characteristics and survival of seven patients with multiple myeloma and orbital are described and analyzed. The common ocular symptoms were blurred vision, proptosis and/or eye movement disorders, IgG type MM may be a risk factor for orbital involvement. Of them, six patients were treated with bortezomib-based regimens. The median overall survival (OS) and progression free survival for the entire cohort were 48 and 33 mo, respectively, which was much worse than the OS reported for MM patients without orbital EMD. CONCLUSION: Orbital MM may have significantly shortened survival for the entire cohort, so multidisciplinary collaboration is emphasized and recommended in the diagnosis and treatment of these difficult cases.

Unusual glomus tumor of the lower leg: A case report.

BACKGROUND: Glomus tumors are rare neoplasms, usually found on the fingers or toes. Glomus tumours that occur in the lower leg are even rarer and is likely to be misdiagnosed or underdiagnosed. This article will document the diagnosis, treatment, and follow-up of a rare glomus tumor of the lower leg, which had been misdiagnosed for up to 15 years. CASE SUMMARY: The patient was a A 36-year-old woman who had suffered from localized pain in her left lower leg for 15 years. After a complete physical examination, a glomus tumor on her lower leg was considered and removed surgically. The specimen was pathologically diagnosed as a glomus tumor. There was no relapse at a 4-year follow-up. CONCLUSION: Correct diagnosis and complete removal of the glomus tumor is important.

Safety considerations during return to work in the context of stable COVID-19 epidemic control: an analysis of health screening results of all returned staff from a hospital.

In March 2020, China had periodically controlled the coronavirus disease-19 (COVID-19) epidemic. We reported the results of health screening for COVID-19 among returned staff of a hospital and conducted a summary analysis to provide valuable experience for curbing the COVID-19 epidemic and rebound. In total, 4729 returned staff from Zhongnan Hospital of Wuhan University, Wuhan, China were examined for COVID-19, and the basic information, radiology and laboratory test results were obtained and systematically analysed. Among the 4729 employees, medical staff (62.93%) and rear-service personnel (30.73%) were the majority. The results of the first physical examination showed that 4557 (96.36%) were normal, 172 (3.64%) had abnormal radiological or laboratory test results. After reexamination and evaluation, four were at high risk (asymptomatic infections) and were scheduled to transfer to a designated hospital, and three were at low risk (infectivity could not be determined) and were scheduled for home isolation observation. Close contacts were tracked and managed by the Center for Disease Control and Prevention (CDC) in China. Asymptomatic infections are a major risk factor for returning to work. Extensive health screening combined with multiple detection methods helps to identify asymptomatic infections early, which is an important guarantee in the process of returning to work.

Fat fraction quantification of lumbar spine: comparison of T1-weighted two-point Dixon and single-voxel magnetic resonance spectroscopy in diagnosis of multiple myeloma.

PURPOSE: We aimed to investigate the value of T1-weighted two-point Dixon technique and single-voxel magnetic resonance spectroscopy (MRS) in diagnosis of multiple myeloma (MM) through quantifying fat content of vertebral marrow. METHODS: A total of 30 MM patients and 30 healthy volunteers underwent T1-weighted two-point Dixon and single-voxel MRS imaging. The fat fraction map (FFM) was reconstructed from the Dixon images using the equation FFM = Lip/In, where Lip represents fat maps and In represents in-phase images. The fat fraction (FF) of MRS was calculated by using the integral area of Lip peak divided by the sum of integral area of Lip peak and water peak. RESULTS: FF values measured by the Dixon technique and MRS were significantly decreased in MM patients (45.99%±3.39% and 47.63%±4.38%) compared with healthy controls (64.43%±0.96% and 76.22%±1.91%) (P < 0.001 with both methods). FF values measured by Dixon technique were significantly positively correlated to those measured by MRS in MM (r = 0.837, P < 0.001) and healthy control group (r = 0.735, P < 0.001), respectively. There was no significant difference between area under the curve (AUC) obtained by the Dixon technique (0.878±0.047; range, 0.785 to 0.971; optimal cutoff, 56.35 for healthy controls vs. MM) and MRS (0.883±0.047; range, 0.791 to 0.974; optimal cutoff, 61.00 for healthy controls vs. MM). The ability of Dixon technique to differentiate MM group from healthy controls was equivalent to single-voxel MRS. CONCLUSION: Regarding detection of fat contents in vertebral bone, T1-weighted two-point Dixon technique exhibited equivalent performance to single-voxel MRS in the diagnosis of multiple myeloma. Moreover, two-point Dixon is a more convenient and stable technique for assessing bone marrow changes in MM patients than single-voxel MRS.

COVID-19: Presumed Infection Routes and Psychological Impact on Staff in Administrative and Logistics Departments in a Designated Hospital in Wuhan, China.

Objective: Our aim was to explore the presumed infection routes and psychological impact of COVID-19 on staff in administrative and logistics departments (ALDs). Methods: We gathered data from all 18 staff members with COVID-19 in ALDs in Zhongnan Hospital of Wuhan University, China. The baseline, job before diagnosis, presumed infection environment, use of protective equipment, and psychological status before and after diagnosis were collected and analyzed. A total of 18 uninfected staff members working alongside them in the same environment and 18 random matched infected doctors and nurses formed two control groups; the psychological impact of these three groups was then compared. Results: Of the 18 members of staff, 88.89% were infected due to the working environment (hospital), and nine had face-to-face conversations with doctors and nurses in their daily work. Many staff members did not take any protective measures in their routine work. Before they were diagnosed, 12 staff members were aware of the seriousness of the epidemic, and most of the staff maintained a neutral attitude to the COVID-19 outbreak. A total of 77.78% of the staff experienced psychological stress or emotional changes after diagnosis, which were mainly caused by family health and disease related issues. Most of them managed their emotions by self-control and video calls with their families. There was no significant difference in psychological impact among the three groups, but uninfected staff members were fully aware of the seriousness of the epidemic. Conclusions: Effective protective measures should be taken for staff members in ALDs. Psychological interventions are very important to help infected staff members in ALDs cope with psychological distress.

Perceived infection transmission routes, infection control practices, psychosocial changes, and management of COVID-19 infected healthcare workers in a tertiary acute care hospital in Wuhan: a cross-sectional survey.

BACKGROUND: Many healthcare workers were infected by coronavirus disease 2019 (COVID-19) early in the epidemic posing a big challenge for epidemic control. Hence, this study aims to explore perceived infection routes, influencing factors, psychosocial changes, and management procedures for COVID-19 infected healthcare workers. METHODS: This is a cross-sectional, single hospital-based study. We recruited all 105 confirmed COVID-19 healthcare workers in the Zhongnan Hospital of Wuhan University from February 15 to 29, 2020. All participants completed a validated questionnaire. Electronic consent was obtained from all participants. Perceived causes of infection, infection prevention, control knowledge and behaviour, psychological changes, symptoms and treatment were measured. RESULTS: Finally, 103 professional staff with COVID-19 finished the questionnaire and was included (response rate: 98.1%). Of them, 87 cases (84.5%) thought they were infected in working environment in hospital, one (1.0%) thought their infection was due to the laboratory environment, and 5 (4.9%) thought they were infected in daily life or community environment. Swab of throat collection and physical examination were the procedures perceived as most likely causing their infection by nurses and doctors respectively. Forty-three (41.8%) thought their infection was related to protective equipment, utilization of common equipment (masks and gloves). The top three first symptoms displayed before diagnosis were fever (41.8%), lethargy (33.0%) and muscle aches (30.1%). After diagnosis, 88.3% staff experienced psychological stress or emotional changes during their isolation period, only 11.7% had almost no emotional changes. Arbidol (Umifenovir; an anti-influza drug; 69.2%) was the drug most commonly used to target infection in mild and moderate symptoms. CONCLUSION: The main perceived mode of transmission was not maintaining protection when working at a close distance and having intimate contact with infected cases. Positive psychological intervention is necessary.

A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version).

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named "2019 novel coronavirus (2019-nCoV)" by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world's attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

Nomograms for predicting long-term overall survival and cancer-specific survival in lip squamous cell carcinoma: A population-based study.

BACKGROUND: The goal of this study was to establish and validate two nomograms for predicting the long-term overall survival (OS) and cancer-specific survival (CSS) in lip squamous cell carcinoma (LSCC). METHODS: This study selected 4175 patients who were diagnosed with LSCC between 2004 and 2015 in the SEER (Surveillance, Epidemiology, and End Results) database. The patients were allocated randomly to a training cohort and validation cohort. Variables were selected using a backward stepwise method in a Cox regression model. Based on the predictive model with the identified prognostic factors, nomograms were established to predict the 3-, 5-, and 8-year survival OS and CSS rates of LSCC patients. The accuracy of the nomograms was evaluated based on the consistency index (C-index), while their prediction accuracy was evaluated using calibration plots. Decision curve analyses (DCAs) were used to evaluate the performance of our survival model. RESULTS: The multivariate analyses demonstrated that age at diagnosis, marital status, sex, race, American Joint Committee on Cancer stage, surgery status, and radiotherapy status were risk factors for both OS and CSS. The C-index, area under the time-dependent receiver operating characteristic curve, and calibration plots demonstrated the good performance of the nomograms. DCAs of both nomograms further showed that they exhibited good 3-, 5-, and 8-year net benefits. CONCLUSIONS: We have developed and validated LSCC prognosis nomograms for OS and CSS for the first time. These nomograms can be valuable tools for clinical practice when clinicians are helping patients to understand their survival risk for the next 3, 5, and 8 years.

Application of fluorescein sodium in breast cancer brain-metastasis surgery.

OBJECTIVE: Surgical resection serves an important role in the multidisciplinary treatment of cerebral metastases (CMs). Conventional white-light, microsurgical, and circumferential stripping of CMs is standard neurosurgical procedure, but is associated with a high recurrence rate. Based on this outcome, there is an urgent need for a new surgical strategy, such as fluorescence-guided resection, for CMs, in order to achieve total removal. METHODS: A retrospective study was carried out in 38 patients clinically and pathologically diagnosed with breast cancer brain metastasis at three medical centers from May 2012 to June 2016. The study comprised group 1 (fluorescein-guided surgery) and group 2 (standard microsurgery). In group 1, 5 mg/kg of fluorescein sodium was injected intravenously after an allergy test and before general anesthesia for 17 patients. A yellow 560 filter was employed for microsurgical tumor resection. Group 2 consisted of 21 patients for whom fluorescein was not administered. RESULTS: Surgical outcomes were assessed concerning the extent of resection and Karnofsky performance status. Gross total resection was achieved in these patients, with high fluorescence markedly enhancing tumor visibility. The extent of resection had a powerful influence on performance status. Overall survival after CM was 24.1 months in patients given fluorescein and was 22.8 months in the nonfluorescein group. CONCLUSION: Fluorescein-guided surgery is a simple, safe, and practical method to resect breast cancer brain metastasis, and leads to a higher proportion of resection compared to common microsurgery. This offers a tremendous advantage when navigating a tiny tumor, and improves the quality of life of patients with CM.

Hardware removal or preservation? Decision making based on a newly developed rating scale.

Hardware exposure following open reduction and internal fixation (ORIF) surgery is a tricky problem. It is always hard for surgeons to decide whether to keep or remove the hardware. In this study, a rating scale and corresponding clinical path is developed based on former published paper as well as our own experience. New admitted patients are first evaluated and scored once they enter the department. Based on the score they get, patients are assigned to different therapeutic schedule, i.e. (1) hardware preservation with pedicel flap transplantation, (2) debridement for further reevaluation and (3) hardware removal with external fixation. Satisfying clinical outcome is achieved that is characterized with high osseous consolidation rate and low complication rate. The result showed that this newly developed rating scale and the related therapeutic schedule could be an available tool to help surgeons to make decisions in the treatment of hardware exposure.

Current perspectives in genetics of "double-hit" lymphoma with possible clinical implications.

This article reviews particular subgroup of B-cell lymphoma, called "double-hit" lymphoma (DHL) because of its distinct aberrations-related genes influencing various processes such as apoptosis, differentiation, and proliferation. Recent studies indicate that tumorigenesis is a complex process involving multiple genes, genetic abnormalities, including gene mutations, deletions, and chromosomal alterations. Chromosomal aberrations are not affecting only basic cellular life preserving activities such as cell proliferation, differentiation, apoptosis, and signal transduction, but are also indispensible for evaluation of lymphoma occurrence, progression, and prognosis as well differential diagnosis and other aspects assessment. DHL is group accompanied by IGH-BCL2 and MYC rearrangement, behaving highly aggressively, with a complex and distinct karyotype which can not be extrapolated solely by morphological pathological assessment, since it has not been entirely characteristic. Therefore, we are reviewing possible effects of multiple genetic rearrangements, particular genes mutations, and developing hypothesis due which pathophysiology mechanisms DHL accomplish synergistic malignant potential.

Expression of 11ß-HSD in steroid-induced avascular necrosis of the femoral head.

The aim of the present study was to investigate the association between glucocorticoid receptors and steroid­induced avascular necrosis of the femoral head (SANFH). Healthy New Zealand rabbits were randomly divided into 3 groups (n=16/group); the normal (no treatment), control (horse serum injections) and treatment (horse serum and methylprednisolone injections) groups. Methylprednisolone and horse serum injections were used to establish a SANFH model in rabbits; magnetic resonance imaging (MRI) and histopathological analysis were used to evaluate the SANFH rabbit model. Total cholesterol and triglyceride contents in the blood of SANFH rabbits were determined. The protein expression levels of 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) and type 2 (11ß-HSD2) were determined using western blotting. The total cholesterol and triglyceride levels in the blood of methylprednisolone­treated rabbits were significantly increased compared with the control and normal groups, which provides evidence in support of the metabolic disorder theory. Based on the results obtained from western blotting, the expression levels of 11ß-HSD1 protein were increased, whereas the expression levels of 11ß-HSD2 protein were decreased following injection. The results of the present study indicate that 11ß-HSDs are important in the development of SANFH. Furthermore, 11ß-HSDs may be important targets for preventing the development of ANFH in patients treated with steroids, which has a significant reference value for the use of steroids in clinical practice.

Activation of cardiac M3 muscarinic acetylcholine receptors has cardioprotective effects against ischaemia-induced arrhythmias.

Increasing evidence indicates the important roles of M(3) muscarinic acetylcholine receptors (M(3) mAChR) in the regulation and maintenance of cardiac function and heart disease. In the present study, we investigated whether the M(3) mAChR mediates the cardioprotection against ischaemia-induced arrhythmias and the mechanisms involved. Myocardial ischaemia was established in Wistar rats by occlusion of the left anterior descending coronary artery. Rats were treated with choline chloride (an M(3) mAChR agonist; 10 mg/kg, i.v.) 10 min before occlusion. In addition, 4-diphenylacetoxy-N-methylpiperidine-methiodide (4-DAMP; 0.12 µg/kg, i.v.) was administered 5 min before choline in the 4-DAMP-treated group. Ischaemia-induced arrhythmias were evaluated in each group for a period of 1 h after occlusion. After 24 h occlusion, protein and mRNA levels of L-type Ca(2+) channels and the Na(+) /Ca(2+) exchanger (NCX) were determined. Ischaemia-induced arrhythmias following coronary artery occlusion were diminished by choline and this effect was reversed in the 4-DAMP-treated group. In vitro, the effects of myocardial ischaemia were simulated by incubating isolated ventricular cardiomyocytes with Tyrode's solution (pH 6.8). Intracellular Ca(2+) overload was confirmed and this was decreased by choline. Furthermore, choline reduced the L-type Ca(2+) current (I(C) (a,) (L) ) compared with cardiomyocytes incubated in Tyrode's solution (pH 6.8) alone. Choline reduced the 'ischaemia'-induced upregulated expression of L-type Ca(2+) channels and NCX at both the protein and mRNA level. Based on these results, choline has an obvious protective effect against ischaemia-induced arrhythmias that is mediated via activation of cardiac M(3) mAChR, which reduces Ca(2+) overload mediated by L-type Ca(2+) channels and the NCX.

The antiarrhythmic effect and possible ionic mechanisms of pilocarpine on animal models.

This study was designed to evaluate the effects of pilocarpine and explore the underlying ionic mechanism, using both aconitine-induced rat and ouabain-induced guinea pig arrhythmia models. Confocal microscopy was used to measure intracellular free-calcium concentrations ([Ca(2+)](i)) in isolated myocytes. The current data showed that pilocarpine significantly delayed onset of arrhythmias, decreased the time course of ventricular tachycardia and fibrillation, reduced arrhythmia score, and increased the survival time of arrhythmic rats and guinea pigs. [Ca(2+)](i) overload induced by aconitine or ouabain was reduced in isolated myocytes pretreated with pilocarpine. Moreover, M(3)-muscarinic acetylcholine receptor (mAChR) antagonist 4-DAMP (4-diphenylacetoxy-N-methylpiperidine-methiodide) partially abolished the beneficial effects of pilocarpine. These data suggest that pilocarpine produced antiarrhythmic actions on arrhythmic rat and guinea pig models induced by aconitine or ouabain via stimulating the cardiac M(3)-mAChR. The mechanism may be related to the improvement of Ca(2+) handling.

The myocardial protective effects of puerarin on STZ-induced diabetic rats.

To investigate the myocardial protective effects of puerarin on streptozotocin (STZ)-induced diabetic rats and the possible mechanism were involved. 45 Sprague-Dawley male rats were randomly divided into 3 groups as diabetic group (intraperitoneally injected STZ 65 mg/kg), puerarin treatment group (intraperitoneally injected STZ 65 mg/kg, and intraperitoneally injected puerarin 100 mg/kg/day for 4 weeks), and control group (intraperitoneally injected saline 6 ml/kg). Four weeks after the model induction, the myocardial changes were observed by H-E stain and Transmission electron microscopy, the alteration of thrombospondin-1 (TSP-1) protein and mRNA expression in the myocardium were also assessed by immunohistochemistry and real-time PCR. The heart function of three groups' rats was tested by Langendorff isolated in vivo heart perfusion. The differences in the data of weight and blood sugar of diabetic between puerarin treatment and normal groups were significant after 4 weeks (P<0.01). Our results demonstrated that diabetic myocardial ultrastructural changes included myofibrillar disarrangements and mitochondria disruption. These damages were significantly less severe in the puerarin treatment group compared with the diabetic group. A significant decrease of TSP-1 expression was observed in the puerarin treated rats' myocardium compared to the diabetic rats (P<0.01). Left ventricular systolic end pressure (LVSEP) and left ventricular developed pressure (LVDP) of puerarin treatment group were also significantly increased compared to diabetic group (P<0.01). Altogether puerarin could improve the left ventricular function of diabetic rats and showed protective effects of myocardium by decreasing the TSP-1 expression in myocardium of diabetic rats.

[Mechanism of the preventing of endotracheal intubation response with esmolol-the relationship between the plasma catecholamine level and bispectral index].

OBJECTIVE: To observe the relationship between the level of catecholamine in plasma with bispectral index during endotracheal intubation with propofol anesthesia in order to investigate the mechanism of the preventing of endotracheal intubation response with esmolol. METHODS: Thirty patients were randomly allocated into two groups: control group (n=15) and esmolol group (n=15). The patients received esmolol 1amg/kg followed by 250 microg/(kgdmin) in esmolol group and saline in control group. Two minutes later, the patients received propofol 2amg/kg for induction. Bispectral index (BIS), systolic pressure (SP), diostolic pressure (DP), and heart rate (HR) were measured before endotracheal intubation and 3amin after intubation, at the same time 8a mL arteral blood was taken for the measurement of the concentrations of norephinephrine(NE) and ephinephrine(E) in plasma. RESULTS: The level of BIS(63.53+/-3.11), NE(2.016+/-0.681)and E(0.578+/-0.072)in control group 3 min after endotracheal intubation were increased significantly than those before intubation (P<0.05), but there were no significant change in the level of BIS, NE and E in esmolol group 3amin after endotracheal intubation . There were significant differences in the concentrations of NE(2.016+/-0.681)and E(0.578+/-0.072) in plasma 3 min after intubation between the two groups (P< 0.05) and there were also significant differences in BIS(63.53+/-3.11) and DeltaBIS(20.93+/-4.57)3 min after intubation between the two groups(P<0.01). SP( 148+/-20)and HR(89+/-180) in control group were increased after intubation than those before intubation (P<0.05) . There were no significant differences in SP, DP and HR in esmolol group after intubation than those before intubation. CONCLUSION: Esmolol can reduce the plasma concentrations of NE and E through preventing periopheal sympathetic nerve response to intubation and can reduce BIS arousal reactions after endotracheal intubation.

[Quantitative study of therapeutic efficacy on early intervention of hyperbaric oxygen to model of steroid-induced avascular osteonecrosis of femoral head by multi-slice perfusion imaging].

OBJECTIVE: To quantitatively evaluate the hemodynamic status in animal models of steroid-induced avascular osteonecrosis of femoral head (SANFH) by multislice CT (MSCT) perfusion imaging, and estimate the therapeutic efficacy on early intervention of hyperbaric oxygen (HBO) to improve the region blood flow (rBF) of ischemic femoral head. METHODS: Forty-eight New Zealand male rabbits were injected with Escherichia coli endotoxin and methyl-prednisolone to establish SANFH models and then divided into 3 subgroups to undergo MSCT to measure the rBF, regional blood volume (rBV), and mean transit time (MTT) to obtain perfusion maps at the femoral head epiphysis, metaphysic, and neck of femur, and then were killed to undergo histological examination of the bilateral femoral heads 2, 4, and 6 weeks later respectively (Groups M(2), M(4), and M(6)). Twenty-four rabbits underwent HOB treatment after the second injection of E. c. endotoxin for 1-3 courses respectively (Groups H(1), H(2), and H(3)), and then underwent MSCT and pathological examination as described above. Eight rabbits were used as controls (Group N). RESULTS: (1) The rBF values of Groups M(2), M(4), and M(6) were all significantly lower than that of Group N (P < 0.001, < 0.001, and < 0.002). The rBF value of femoral head epiphysis of Group M(2) was remarkably lower than that of Group N, decreased to the lowest in Group M(4), and re-increased in Group M(6). The rBV value demonstrated similar change pattern in femoral head epiphysis. The MTT values of Groups M(2) and M(4) were longer than that of Group N, and then re-decreased in Group M(6). (2) It did differ significantly between the perfusion data of different femoral head anatomic regions in Groups M(2), M(4), M(6) and N (rBF: F = 52.190, P < 0.001; rBV: F = 42.677, P < 0.001; MTT: F = 3.09, P = 0.048). The changes of the perfusion data in femoral head epiphysis were more significant than those in other anatomic regions. (3) There were no statistically significant differences in the rBF value of the femoral head epiphysis and metaphysis (F = 2.081, P = 0.115; F = 1.142, P = 0.341), in the rBV value of the femoral metaphysis and neck of femur (F = 2.642, P = 0.059; F = 1.568, P = 0.209), and the MTT value of all the anatomic regions (F = 1.111, P = 0.347) among Groups H(1), H(2), H(3), and N. The rBF values of Groups H(1), H(2), and H(3) were statistically higher than those of the corresponding phase model groups (all P < 0.05). CONCLUSIONS: Able to detect hemodynamic status of femoral head, MSCT perfusion imaging technique may be used in the early detection of SANFH. Early intervention of HBO therapy can improve the blood perfusion of femoral head.