Immunomodulatory effects of hydatid antigens on mesenchymal stem cells: gene expression alterations and functional consequences.

Background: Cystic echinococcosis, caused by the larval stage of Echinococcus granulosus, remains a global health challenge. Mesenchymal stem cells (MSCs) are renowned for their regenerative and immunomodulatory properties. Given the parasite's mode of establishment, we postulate that MSCs likely play a pivotal role in the interaction between the parasite and the host. This study aims to explore the response of MSCs to antigens derived from Echinococcus granulosus, the etiological agent of hydatid disease, with the hypothesis that exposure to these antigens may alter MSC function and impact the host's immune response to the parasite. Methods: MSCs were isolated from mouse bone marrow and co-cultured with ESPs, HCF, or pLL antigens. We conducted high-throughput sequencing to examine changes in the MSCs' mRNA expression profile. Additionally, cell cycle, migration, and secretory functions were assessed using various assays, including CCK8, flow cytometry, real-time PCR, Western blot, and ELISA. Results: Our analysis revealed that hydatid antigens significantly modulate the mRNA expression of genes related to cytokine and chemokine activity, impacting MSC proliferation, migration, and cytokine secretion. Specifically, there was a downregulation of chemokines (MCP-1, CXCL1) and pro-inflammatory cytokines (IL-6, NOS2/NO), alongside an upregulation of anti-inflammatory mediators (COX2/PGE2). Furthermore, all antigens reduced MSC migration, and significant alterations in cellular metabolism-related pathways were observed. Conclusion: Hydatid disease antigens induce a distinct immunomodulatory response in MSCs, characterized by a shift towards an anti-inflammatory phenotype and reduced cell migration. These changes may contribute to the parasite's ability to evade host defenses and persist within the host, highlighting the complex interplay between MSCs and hydatid disease antigens. This study provides valuable insights into the pathophysiology of hydatid disease and may inform the development of novel therapeutic strategies.

Treatment of tibial bone defects caused by infection: a retrospective comparative study of bone transport using a combined technique of unilateral external fixation over an intramedullary nail versus circular external fixation over an intramedullary nail.

BACKGROUND: The purpose of the study was to assess and compare the clinical efficacy of bone transport with either circular or unilateral external fixators over an intramedullary nail in the treatment of tibial bone defects caused by infection. METHODS: Between May 2010 and January 2019, clinical and radiographic data were collected and analyzed for patients with bone defects caused by infection. Thirteen patients underwent bone transport using a unilateral external fixator over an intramedullary nail (Group A), while 12 patients were treated with a circular external fixator over an intramedullary nail (Group B). The bone and functional outcomes of both groups were assessed and compared using the Association for the Study and Application of the Method of the Ilizarov criteria, and postoperative complications were evaluated according to the Paley classification. RESULTS: A total of 25 patients were successfully treated with bone transport using external fixators over an intramedullary nail, with a mean follow-up time of 31.63 ± 5.88 months. There were no significant statistical differences in age, gender, previous surgery per patient, duration of infection, defect size, and follow-up time between Group A and Group B (P > 0.05). However, statistically significant differences were observed in operation time (187.13 ± 21.88 min vs. 255.76 ± 36.42 min, P = 0.002), intraoperative blood loss (39.26 ± 7.33 mL vs. 53.74 ± 10.69 mL, P < 0.001), external fixation time (2.02 ± 0.31 month vs. 2.57 ± 0.38 month, P = 0.045), external fixation index (0.27 ± 0.08 month/cm vs. 0.44 ± 0.09 month/cm, P = 0.042), and bone union time (8.37 ± 2.30 month vs. 9.07 ± 3.12, P = 0.032) between Group A and Group B. The excellent and good rate of bone and functional results were higher in Group A compared to Group B (76.9% vs. 75% and 84.6% vs. 58.3%). Statistically significant differences were observed in functional results (excellent/good/fair/poor, 5/6/2/0 vs. 2/5/4/1, P = 0.013) and complication per patient (0.38 vs. 1.16, P = 0.012) between Group A and Group B. CONCLUSIONS: Bone transport using a combined technique of external fixators over an intramedullary nail proved to be an effective method in treating tibial bone defects caused by infection. In comparison to circular external fixators, bone transport utilizing a unilateral external fixator over an intramedullary nail resulted in less external fixation time, fewer complications, and better functional outcomes.

Is fracture management merely a physical process? Exploring the psychological effects of internal and external fixation.

BACKGROUND: Internal and external fixation are common surgical procedures for treating fractures. However, the impact of different surgical approaches (including internal and external fixations) on patients' psychological status and Quality of Life (QoL) is rarely examined. Herein, we aimed to investigate the effects of internal and external fixation on anxiety, depression, insomnia, and overall mental and physical health in Distal Radius Fractures (DRF) patients. METHODS: We performed a retrospective study on 96 fracture patients who underwent internal fixation (57 patients) or external fixation (39 patients). The Visual Analog Scale (VAS), the Hospital Anxiety and Depression Scale (HADS), the Athens Insomnia Scale (AIS), and the Medical Outcomes Study Short Form 36 (SF-36) questionnaire were used to assess the patients' pain, anxiety, depression, sleep, and QoL before surgery and at seven days, one month, and three months post-surgery. RESULTS: The VAS scores were significantly lower in the Internal Fixation Group (IFG) than in the External Fixation Group (EFG) on the seventh day and one month postoperatively (P < 0.05). Although both groups showed no significant anxiety, depression, or insomnia before surgery (P > 0.05), the EFG showed significantly higher HADS-A, HADS-D, and AIS scores than the IFG at seven days and one and three months postoperatively (P < 0.05). Additionally, changes in HADS-A, HADS-D, and AIS scores were most significant at day seven post-surgery in the EFG (P < 0.05). Furthermore, no significant difference was found between the two groups in the average Physical Component Summary (PCS) and Mental Component Summary (MCS) scores before surgery (P > 0.05). However, both groups showed positive changes in PCS and MCS scores at postoperative day seven and one and three months postoperatively, with the IFG having significantly higher average PCS and MCS scores compared to the EFG (P < 0.05). CONCLUSION: Compared to external fixation, internal fixation did not significantly impact patients' emotions regarding anxiety and depression in the early postoperative period, and physical and mental health recovery was better during the postoperative rehabilitation period. Furthermore, when there are no absolute indications, the impact on patients' psychological well-being should be considered as one of the key factors in the treatment plan during surgical approach selection.

Exploration of altered miRNA expression and function in MSC-derived extracellular vesicles in response to hydatid antigen stimulation.

Background: Hydatid disease is caused by Echinococcus parasites and can affect various tissues and organs in the body. The disease is characterized by the presence of hydatid cysts, which contain specific antigens that interact with the host's immune system. Mesenchymal stem cells (MSCs) are pluripotent stem cells that can regulate immunity through the secretion of extracellular vesicles (EVs) containing microRNAs (miRNAs). Methods: In this study, hydatid antigens were isolated from sheep livers and mice peritoneal cavities. MSCs derived from mouse bone marrow were treated with different hydatid antigens, and EVs were isolated and characterized from the conditioned medium of MSCs. Small RNA library construction, miRNA target prediction, and differential expression analysis were conducted to identify differentially expressed miRNAs. Functional enrichment and network construction were performed to explore the biological functions of the target genes. Real-time PCR and Western blotting were used for miRNA and gene expression verification, while ELISA assays quantified TNF, IL-1, IL-6, IL-4, and IL-10 levels in cell supernatants. Results: The study successfully isolated hydatid antigens and characterized MSC-derived EVs, demonstrating the impact of antigen concentration on MSC viability. Key differentially expressed miRNAs, such as miR-146a and miR-9-5p, were identified, with functional analyses revealing significant pathways like Endocytosis and MAPK signaling associated with these miRNAs' target genes. The miRNA-HUB gene regulatory network identified crucial miRNAs and HUB genes, such as Traf1 and Tnf, indicating roles in immune modulation and osteogenic differentiation. Protein-protein interaction (PPI) network analysis highlighted central HUB genes like Akt1 and Bcl2. ALP activity assays confirmed the influence of antigens on osteogenic differentiation, with reduced ALP activity observed. Expression analysis validated altered miRNA and chemokine expression post-antigen stimulation, with ELISA analysis showing a significant reduction in CXCL1 expression in response to antigen exposure. Conclusion: This study provides insights into the role of MSC-derived EVs in regulating parasite immunity. The findings suggest that hydatid antigens can modulate the expression of miRNAs in MSC-derived EVs, leading to changes in chemokine expression and osteogenic capacity. These findings contribute to a better understanding of the immunomodulatory mechanisms involved in hydatid disease and provide potential therapeutic targets for the development of new treatment strategies.

Isoflavones isolated from chickpea sprouts alleviate ovariectomy-induced osteoporosis in rats by dual regulation of bone remodeling.

Osteoporosis is a common systemic skeletal disease and a predominant underlying factor in the increased occurrence of fractures. The structure of isoflavones resembles that of estrogen and can confer similar but weaker effects. This study investigated the potential inhibitory effects of isoflavones from chickpea sprouts (ICS) on ovariectomy (OVX)-induced osteoporosis in vitro and in vivo. Notably, we found that ICS treatment could attenuate bone loss and improve trabecular microarchitecture and biomechanical properties of the fourth lumbar vertebra in OVX-induced osteoporotic rats and could also inhibit the development of a hyperosteometabolic state in this model. The osteogenic differentiation of bone marrow stem cells (BMSCs) was significantly enhanced by ICS intervention in vitro, and we confirmed that estrogen receptor α signaling was required for this increased osteogenic differentiation. Additionally, ICS has been shown to inhibit bone resorption via ERa modulation of the OPG/RANKL pathway. RANKL-induced osteoclastogenesis was reduced under ICS treatment, supporting that NF-κB signaling was inhibited by ICS. Thus, ICS attenuates osteoporosis progression by promoting osteogenic differentiation and inhibiting osteoclastic resorption. These results support the further exploration and development of ICS as a pharmacological agent for the treatment and prevention of osteoporosis.

Giant muscle hydatid in lower extremity: a rare case with neurological symptoms as the first manifestation.

BACKGROUND: Human hydatid disease typically occurs in organs such as the liver and kidney. Primary solitary intramuscular hydatid disease, however, is rare. CASE PRESENTATION: We report a case of a giant muscle hydatid in the lower extremity, with neurological symptoms as the first manifestation. The symptoms specifically manifested as intermittent pain in the right lower extremity and numbness in the sole of the right foot. However, there were no obvious abnormalities detected in electromyography and lumbar MRI. Subsequent ultrasonography and calf MRI showed that the patient had cystic lesions in the calf. The patient was initially diagnosed with a muscle hydatid cyst. Treatment involved complete surgical excision of the lesion, and the diagnosis of a hydatid cyst was confirmed through macroscopic and microscopic histopathological examination after the mass was excised. The patient was given oral albendazole, and no recurrence was observed during the 12 months of follow-up. CONCLUSIONS: This case underscores the need to consider hydatid disease when diagnosing soft tissue masses in muscles, particularly in endemic areas. Patients may initially present with atypical symptoms like peripheral nerve issues.

Mechanisms underlying the therapeutic effects of isoflavones isolated from chickpea sprouts in treating osteoporosis based on network pharmacology.

Osteoporosis is a systemic bone disease that is caused by multiple factors that lead to an imbalance in bone metabolism. Isoflavones can prevent and treat osteoporosis by regulating bone metabolism through a variety of pathways. The germination of chickpeas can significantly increase their isoflavone contents. However, the use of isoflavones isolated from chickpea sprouts (ICS) to prevent and treat osteoporosis by regulating bone metabolism has not been widely studied. In vivo experimental studies in ovariectomized rats showed that ICS significantly improved femoral bone mineral density (BMD) and trabecular structure, with effects similar to raloxifene. Furthermore, the chemical composition of ICS as well as the targets and signalling pathways its regulates in the prevention and treatment of osteoporosis were predicted by network pharmacological studies. ICS with drug-like properties were identified by Lipinski's 5 principles, and intersecting targets of isoflavones with osteoporosis were identified. The overlapping targets were analysed by PPI, GO and KEGG analyses, and the possible key targets, signalling pathways and biological processes by which ICS treats osteoporosis were predicted; the prediction results were verified by molecular docking technology. The results showed that ICS could play an important role in the treatment of osteoporosis through "multicomponent, multitarget and multipathway" mechanisms, and the MAKP, NF-kB and ER-related signalling pathways may be important pathways by which ICS regulates osteoporosis; these findings provide a new theoretical basis for further experimental studies.

Risk factors associated with tendon adhesions after hand tendon repair.

Background: Tendon adhesions after hand tendon repair are one of the most difficult complications of hand surgery and can cause severe disability. This study aimed to assess the risk factors associated with tendon adhesions after hand tendon repair to provide a theoretical foundation for the early prevention of tendon adhesions in patients with tendon injuries. Moreover, this study intends to increase doctors' awareness of the issue and serves as a reference for developing new prevention and treatment strategies. Methods: We retrospectively analyzed 1,031 hand trauma cases that underwent repair after finger tendon injury in our department between June 2009 and June 2019. Tendon adhesions, tendon injury zones, and other relevant information were collected, summarized, and analyzed. The significance of data was determined using a t-test or Pearson's chi-square test, and odds ratios (OR) were calculated using logistic regression tests to describe factors associated with post-tendon repair adhesions. Results: A total of 1,031 patients were enrolled in this study. There were 817 males and 214 females with an average age of 34.98 (2-82) years. The injured side included 530 left and 501 right hands. Postoperative finger tendon adhesions occurred in 118 cases (11.45%), including 98 males and 20 females, 57 left and 61 right hands. The risk factors for the total sample in the descending order were degloving injury, no functional exercise, zone II flexor tendon injury, time from injury to surgery >12 h, combined vascular injury, and multiple tendon injuries. The flexor tendon sample shared the same risk factors as the total sample. Risk factors for the extensor tendon sample were degloving injury, no functional exercise. Conclusions: Clinicians should pay close attention to patients with tendon trauma in hand having the following risk factors: degloving injury, zone II flexor tendon injury, lack of functional exercise, time from injury to surgery >12 h, combined vascular injury, and multiple tendon injuries. Due to the high risk of post-repair adhesions in patients with the conditions mentioned above, individualized treatment measures should be designed for the risk factors, and postoperative functional exercise of the hand is required.

Complete excision of giant clavicular hydatid cyst: a case report.

BACKGROUND: Echinococcosis, also known as hydatid disease, is a zoonotic parasitic disease prevalent in pastoral areas, mainly involving the liver and lungs, and less frequently the bones and surrounding soft tissues. Diagnosis and treatment of bone hydatid disease is a challenge, and because of the insidious course of the disease, the lesions are often widely disseminated by the time patients seek medical attention. CASE PRESENTATION: A 29-year-old woman presented with a painless mass that was gradually increasing in size in the cervical thorax. Imaging revealed an enlarged clavicle with multiple bone cortical defects and the existence of cysts in the soft tissues surrounding the clavicle, for which complete excision of the clavicle and the attached cysts was performed. There was no recurrence of the cyst within one year after the operation, and the patient felt well and had normal shoulder joint movement. CONCLUSIONS: Bone hydatid may appear in bones throughout the body, and cysts that leak from the bone into the surrounding soft tissues may spread at a relatively rapid rate. Prompt surgical removal of the affected bone and surrounding cysts is necessary for treatment.

Self-Assembled KLD-12/SDF-1 Polypeptide Promotes Differentiation and Migration of BMSCs via the Wnt/ß-catenin Signaling Pathways.

OBJECTIVE: This study aimed to evaluate the combination of SDF-1 and KLD-12 to form self-assembling polypeptide and its effect on osteogenic differentiation. METHODS: ELISA assay was performed to detect whether KLD-12 composite SDF-1 self-assembled polypeptide was successfully prepared. BMSCs were isolated and characterized by Flow cytometry. MTT assays, Calcein-AM/PI fluorescence staining, and Glycosaminoglycans (GAGs) measurement were carried out to detect cell viability after cells exposed to KLD-12 composite SDF-1 selfassembled polypeptide. The migration of cells induced by KLD-12 composite SDF-1 selfassembled polypeptide was also examined by transwell assay and Immunoblot. Osteogenic differentiation of cells stimulated with KLD-12 composite SDF-1 self-assembled polypeptide was analyzed by Immunoblot, Alizarin Red Staining, and Alkaline Phosphatase activity. Additionally, immunoblot and immunofluorescence assays were performed to investigate the effects of the polypeptide on the Wnt/ß-catenin pathway. RESULTS: KLD-12 composite SDF-1 self-assembled polypeptide was successfully prepared and identified. In addition, we isolated and characterized mouse mesenchymal stem BMSCs. Our data further revealed that KLD-12 combined with SDF-1 self-assembled polypeptide improved the survival of BMSCs and promoted cell migration. Moreover, the self-assembled polypeptide induced osteogenic differentiation of BMSCs. Mechanically, we found that the self-assembled polypeptide activated the Wnt/ß-catenin pathway, therefore promoting the differentiation and migration of BMSCs. CONCLUSION: Our proposed treatment can potentially be effective for bone defects.

The role of the medial buttress plate in the treatment of Pauwels type II and III femoral neck fracture in nonelderly patients: a retrospective study and preliminary results.

BACKGROUND: The purpose of this study was to compare the effectiveness of multiple cannulated screws combined with medial buttress plate or not for the treatment of unstable femoral neck fracture in nonelderly patients. METHODS: Sixty-nine nonelderly patients with Garden type III-IV femoral neck fracture were retrospectively analyzed. The patients were divided into MCS (multiple cannulated screws) group and CMBP (combined with medial buttress plate) group according to the surgical method. Patient's demographic data, Harris Hip Score, EQ-5D index and complications at a minimum of 2 years follow-up were analyzed. RESULTS: There were 47 patients in the MCS group (35 male and 12 females) with a mean age of 40.28 ± 12.64 years, whereas 22 patients in the CMBP group (17 male and 5 females) with a mean age of 43.86 ± 12.55 years. In the MCS group, there were 1 (2.1%) avascular necrosis, 5 (10.6%) postoperative nonunion, 5 (10.6%) implant failure, and 2 (4.3%) femoral neck shortening. While 1 (4.5%) implant failure, 2 (9.1%) postoperative nonunion and 2 (9.1%) impingement in the CMBP group. For patients with Pauwels type II and III femoral neck fracture, the CMBP group had higher HHS scores at 3 months after surgery than the MCS group (P < 0.05), whereas there was no statistical significance at 6 months, 1 year, and 2 years (P > 0.05). The same results were found in the EQ-5D index. CONCLUSIONS: In our cohort, we observed better outcomes in the CMBP group at 3 and 6 months, with later results similar between groups. However, there were fewer complications in the CMBP group, without obviously blood-supply disruption, especially in Pauwels type II and III. Further, anatomic reduction and stable fixation may contribute to satisfactory outcomes in the treatment of nonelderly displaced femoral neck fractures.

Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation.

OBJECTIVE: To evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III-V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment. METHODS: Twenty-five patients diagnosed with Rockwood III-V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC-Dist) using orthophoria X-ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale. RESULTS: All the patients were followed up three to four times in 18 months (12-24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC-Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement. CONCLUSION: Due to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III-V dislocation of AC joint.

Effects of intramedullary nailing fixation on quality of life and joint function in patients with femoral neck fractures.

OBJECTIVE: This study intended to investigate the changes in quality of life and joint function after intramedullary nailing fixation in patients with femoral neck fractures. METHODS: A total of 38 patients with femoral neck fractures received surgical treatment from February 2016 to November 2018 were enrolled as study subjects, and were divided into the intramedullary nailing group (IIN group, n=13) and the plate fixation group (PO group, n=25). The efficacy, general surgical indices, postoperative complications, hip function scores and imaging results were compared between the two groups. RESULTS: The response rate of the IIN group was 100.00%, significantly higher than 72.00% of the PO group (P<0.05). The length of hospital stay, blood loss, and the length of the healing period in the IIN group were lower than those in the PO group (P<0.05). The incidence of infection, deformity, loosening of internal fixation, and failed internal fixation in the PO group were significantly higher those than in the INN group (P<0.05). At 3, 6, and 12 months after surgery, the INN group had higher Harris scores and SF-36 scores than the PO group (P<0.05). The response rates of Harris scores of patients in the IIN group were significantly higher than those in the PO group at 12 months postoperatively (P<0.05). CONCLUSION: Intramedullary nailing fixation in patients with femoral neck fractures has the advantages of a shorter time in bed and better functional recovery, lower incidence of complications and higher long-term joint function with better quality of life.

The efficiency of internal fixation with bone grafting at docking sites after bone transport for treatment of large segmental tibial bone defects.

OBJECTIVE: To investigate the efficiency of internal fixation with bone grafting after bone transport for treatment in large-segment bone defects of the lower-limbs. METHODS: This prospective study recruited 100 patients with lower limb tibial segmental bone defects, and based on a random number table they were divided into a control group (n=50, simple bone transport surgery) or an observation group (n=50, internal fixation with bone grafting at docking site after bone transport). The fracture healing time, bone healing index, external fixation time in both groups were compared. The knee function, joint range of motion, and the function of the ankle and hindfoot before and after surgery were also analyzed and compared between the two groups respectively, as well as the rate of complications in both groups was calculated. RESULTS: Compared with the preoperative condition of patients, the Lysholm knee scale, ROM score, and AHS scores of patients in the two groups were significantly increased 10 months after surgery, moreover, those scores of the observation group were higher than that of the control group (P<0.05). The fracture healing time and external fixation time of patients were significantly declined in the observation group when compared to the control group, additionally, the bone healing index was also reduced significantly (P<0.05). When compared with patients in the control group, the ratios of bone healing and lower-limb functional recovery of patients in the observation group were significantly higher while the total complication incidence was decreased remarkably (P<0.05). CONCLUSION: Internal fixation with bone grafting after bone transport can promote fracture healing, improve joint function, and reduce complications during treatment for a large segmental bone defects in the lower limbs.

Outcomes of Radiotherapy for Osseous Echinococcosis of Meriones meridianus.

BACKGROUND: Osseous cyst echinococcosis (CE) is an infectious disease that causes disability and deformity in patients, yet there is still no satisfactory treatment. Focusing on the feasibility and prognosis of radiotherapy as an adjuvant or palliative treatment for osseous CE, this study investigated the outcome of Meriones meridianus with osseous CE after radiotherapy. METHODS: The study utilized a comparison control group design with three groups of gerbils, and 240 osseous CE gerbils were randomly divided into control, 40Gy/5times, and 50Gy/5times groups. Different doses of radiotherapy were given to the gerbils, and then, the effects of radiotherapy on gerbils and lesions were observed at 3 and 6 months after radiotherapy. Statistical analysis was done using χ 2 test, unpaired t-test, and one-way ANOVA. RESULTS: Significant changes (P < 0.05) were achieved between the three groups in terms of seven parameters at 3 and 6 months, including the number of dead gerbils and lesion sites with ulceration and infection, number of dead scolices, protein content, Ca2+ concentration, the maximum diameter of lesion site, and wet weight of cysts. Except for the number of dead gerbils and lesion sites with ulceration and infection, all other parameters were observed a big difference between 3 months and 6 months in the 50Gy/5times group. CONCLUSION: Radiotherapy at a dose of 50 Gy has inhibitory and therapeutic effects on osseous CE in gerbils, and radiotherapy could probably be a treatment option for persistent or recurrent osseous CE.

Surgery or radiotherapy for the treatment of bone hydatid disease: a retrospective case series.

BACKGROUND: Currently, there is no accepted treatment for inoperable bone hydatid disease where medical treatment has proved ineffective. Alternative treatment strategies are therefore urgently needed. Radiotherapy may constitute a treatment option, but there is currently a lack of adequate evidence. This study sought to retrospectively assess the efficacy and safety of surgery or radiotherapy in the treatment of bone hydatid disease in patients attending a single hospital in China. METHODS: This was a retrospective case series analyzing clinical data from consecutive patients treated between January 2000 and December 2011. Patients with an Echinococcus sp infection were counselled about their disease and the potential treatment options, and made an informed decision between surgery and radiotherapy. All patients were followed up. The treatment outcome was observed in the two treatment groups based on the frequencies of relapse and complications, and self-evaluated patient satisfaction. RESULTS: Of 40 patients (age range 25-57 years), 24 opted for surgery and 16 for radiotherapy. Relapse occurred in 14 patients (58%) post-surgery and in three patients (21%) post-radiotherapy. Bone defects, limb movement disorders, and pain were reported in seven patients (29%) post-surgery, while two patients (13%) reported hardening of the irradiated region or a limb after radiotherapy. Titres of parasite-specific antibodies decreased significantly after radiotherapy but not after surgical intervention. Patient satisfaction was significantly higher in the radiotherapy group. CONCLUSION: This retrospective case series describes, for the first time, the clinical outcomes in a series of patients treated with radiotherapy for bone hydatid disease. Although no direct comparison between the treatment groups could be made due to methodological limitations of the study design, this study indicates that well-designed prospective randomized controlled clinical trials assessing radiotherapy may be warranted in patients with inoperable hydatid disease of the bones.

Curative effect of radiotherapy at various doses on subcutaneous alveolar echinococcosis in rats.

BACKGROUND: Alveolar echinococcosis (AE) is a disease in human and animals, and the cure rate is unsatisfactory. This study aimed to investigate the curative efficacy of different doses of locally applied radiotherapy on alveolar echinococcosis in rats. METHODS: Rats infected with Echinococcus multilocularis were randomly divided into 4 groups of 15 rats each: low-, middle-, and high-irradiation groups and a control group. Rats in the control group underwent no treatment, while rats in the irradiation groups received 6-MeV radiotherapy at 20 Gy/8 f, 40 Gy/8 f, and 60 Gy/8 f respectively, once every 3 days for a total of 8 times. One month after radiotherapy, wet weight and AE vesicle inhibitory rate were detected in rats of each group. Histopathologic and ultrastructural observations of tissues with AE lesions were performed. RESULTS: In the treatment groups, an obvious inhibitory effect was found in AE rats; the inhibitory rates were 50%, 72%, and 82%, respectively. There were also statistical differences in pathological changes and average wet weight of the lesions compared with the control group (P < 0.05). In the treatment groups, injuries of various degrees were found in the ultrastructure of the laminated and germinal layers in the capsular wall of AE, and injury was most severe in the high-dose group. CONCLUSION: Radiotherapy has a dose-dependent inhibitory effect on the growth of AE.

[X-ray irradiation against Echinococcus multilocularis protoscoleces in vitro].

OBJECTIVE: To explore the effect of X-ray irradiation on Echinococcus multilocularis protoscoleces in vitro. METHODS: Echinococcus multilocularis protoscoleces were collected from cysts of infected Meriones meridianus and then cultured in RPMI 1640 medium. Protoscoleces were subpackaged into culture flasks at a density of about 10(4) per flask after culture for 3 days. Each group has 10 culture flasks. There were seven groups named as blank control group, low dose group (15 Gy and 30 Gy), medium dose group (45 Gy and 60 Gy), high dose group (75 Gy and 90 Gy), albendazole group (2 500 ng/ml), 45 Gy X-ray + 2 500 ng/ml albendazole group, and 75 Gy X-ray + 2 500 ng/ml albendazole group. Protoscoleces received three radiations on every other day with a source-skin distance of 100 cm and at a dose rate of 200 cGy/min after 3 days in culture. At each day after irradiation, protoscoleces were counted by light microscope with 0.1% eosin staining, and calculated mortality rate (per 100 protoscoleces) until all the parasites in experimental groups died. At the same time, the morphological changes of protoscoleces were observed. RESULTS: There were significant differences in protoscolex mortality between X-ray groups and blank control group (P < 0.05), between X-ray + albendazole groups and albendazole group (P < 0.05). Protoscolex mortality in albendazole group were higher than that of blank control group (P < 0.05). Significant difference were also found in protoscolex mortality between albendazole combined with radiation and radiation only (P < 0.05). Before radiation, protoscoleces was normal with complete structure. After radiation, the parasites were mostly valgus type protoscoleces with disordered rostellar hooks and deformed acetabulum, and finally died. CONCLUSION: X-ray can kill Echinococcus multilocularis protoscoleces in vitro.

[Effect of 6 MeV radiotherapy on secondary Echinococcus multilocularis infection in rats].

OBJECTIVE: To explore the effect of 6-MeV X-ray radiotherapy on secondary Echinococcus multilocularis infection in rats. METHODS: Female SD rats were used to develop a secondary infection model, and then randomly divided into experimental group and control group (5/group). Rats in experimental group received two irradiations at 7-day intervals with the same dose (20 Gy) which applied with 6-MeV ray. The rats in control group did not receive any treatment. At one month after the second irradiation, the pathomorphological changes of E. multilocularis cysts were observed. RESULTS: Cysts in experimental group showed different degrees of damage, including that the laminated layer and germinal layer became swollen and separated from each other, brood capsules and protoscoleces were rare. The structure of cysts was normal in control group, laminated layer and germinal layer were clear, and there were many protoscoleces in the brood capsule. CONCLUSION: 6 MeV radiotherapy can inhibit the growth of E. multilocularis.