Cardiac radiation improves ventricular function in mice and humans with cardiomyopathy.

BACKGROUND: Rapidly dividing cells are more sensitive to radiation therapy (RT) than quiescent cells. In the failing myocardium, macrophages and fibroblasts mediate collateral tissue injury, leading to progressive myocardial remodeling, fibrosis, and pump failure. Because these cells divide more rapidly than cardiomyocytes, we hypothesized that macrophages and fibroblasts would be more susceptible to lower doses of radiation and that cardiac radiation could therefore attenuate myocardial remodeling. METHODS: In three independent murine heart failure models, including models of metabolic stress, ischemia, and pressure overload, mice underwent 5 Gy cardiac radiation or sham treatment followed by echocardiography. Immunofluorescence, flow cytometry, and non-invasive PET imaging were employed to evaluate cardiac macrophages and fibroblasts. Serial cardiac magnetic resonance imaging (cMRI) from patients with cardiomyopathy treated with 25 Gy cardiac RT for ventricular tachycardia (VT) was evaluated to determine changes in cardiac function. FINDINGS: In murine heart failure models, cardiac radiation significantly increased LV ejection fraction and reduced end-diastolic volume vs. sham. Radiation resulted in reduced mRNA abundance of B-type natriuretic peptide and fibrotic genes, and histological assessment of the LV showed reduced fibrosis. PET and flow cytometry demonstrated reductions in pro-inflammatory macrophages, and immunofluorescence demonstrated reduced proliferation of macrophages and fibroblasts with RT. In patients who were treated with RT for VT, cMRI demonstrated decreases in LV end-diastolic volume and improvements in LV ejection fraction early after treatment. CONCLUSIONS: These results suggest that 5 Gy cardiac radiation attenuates cardiac remodeling in mice and humans with heart failure. FUNDING: NIH, ASTRO, AHA, Longer Life Foundation.

Evaluating phase II results of Baxdrostat, an aldosterone synthase inhibitor for hypertension.

INTRODUCTION: Hypertension, a global health concern, poses a significant risk for other cardiovascular diseases. While lifestyle modifications and interventions like the Dietary Approaches to Stop Hypertension (DASH) diet offer some respite, their maintenance can be challenging. Recently, the spotlight has turned toward the renin-angiotensin-aldosterone system, a crucial player in the pathophysiology of hypertension. Contrary to other drugs, Baxdrostat, an innovative aldosterone synthase inhibitor (ASI), targets aldosterone synthesis, mitigating negative systemic effects. AREAS COVERED: Baxdrostat showcases rapid absorption, high oral bioavailability, and significant selectivity for aldosterone synthase which presents a proactive approach to hypertension management by reducing aldosterone levels. Early trials have demonstrated its potential in lowering blood pressure in resistant hypertension cases. Current clinical trials are also exploring its application in primary aldosteronism and chronic kidney disease, with preliminary findings indicating its promise as a novel antihypertensive agent. This article encapsulates the current state of knowledge regarding Baxdrostat, encompassing its uses, ongoing clinical trials, and potential future clinical applications. EXPERT OPINION: Future research endeavors will play a pivotal role in unveiling the effectiveness and safety profile of this novel medication. Thus, positioning the baxdrostat as a valuable addition to the armamentarium of antihypertensive agents, especially for patients with complex, multifactorial hypertensive conditions.

Modulation of lncRNA links endothelial glycocalyx to vascular dysfunction of tyrosine kinase inhibitor.

AIMS: Novel cancer therapies leading to increased survivorship of cancer patients have been negated by a concomitant rise in cancer therapies-related cardiovascular toxicities. Sunitinib, a first line multi-receptor tyrosine kinase inhibitor, has been reported to cause vascular dysfunction although the initiating mechanisms contributing to this side effect remain unknown. Long non-coding RNAs (lncRNAs) are emerging regulators of biological processes in endothelial cells (ECs); however, their roles in cancer therapies-related vascular toxicities remain underexplored. METHODS AND RESULTS: We performed lncRNA expression profiling to identify potential lncRNAs that are dysregulated in human-induced pluripotent stem cell-derived ECs (iPSC-ECs) treated with sunitinib. We show that the lncRNA hyaluronan synthase 2 antisense 1 (HAS2-AS1) is significantly diminished in sunitinib-treated iPSC-ECs. Sunitinib was found to down-regulate HAS2-AS1 by an epigenetic mechanism involving hypermethylation. Depletion of HAS2-AS1 recapitulated sunitinib-induced detrimental effects on iPSC-ECs, whereas CRISPR-mediated activation of HAS2-AS1 reversed sunitinib-induced dysfunction. We confirmed that HAS2-AS1 stabilizes the expression of its sense gene HAS2 via an RNA/mRNA heteroduplex formation. Knockdown of HAS2-AS1 led to reduced synthesis of hyaluronic acid (HA) and up-regulation of ADAMTS5, an enzyme involved in extracellular matrix degradation, resulting in disruption of the endothelial glycocalyx which is critical for ECs. In vivo, sunitinib-treated mice showed reduced coronary flow reserve, accompanied by a reduction in Has2os and degradation of the endothelial glycocalyx. Finally, we identified that treatment with high molecular-weight HA can prevent the deleterious effects of sunitinib both in vitro and in vivo by preserving the endothelial glycocalyx. CONCLUSIONS: Our findings highlight the importance of lncRNA-mediated regulation of the endothelial glycocalyx as an important determinant of sunitinib-induced vascular toxicity and reveal potential novel therapeutic avenues to attenuate sunitinib-induced vascular dysfunction.

Patterns of labral tears and cartilage injury are different in femoroacetabular impingement and dysplasia.

The aim of this study was to assess injury patterns and risk factors of the acetabular labrum and associated cartilage in patients with femoroacetabular impingement (FAI) versus dysplasia. We retrospectively reviewed 137 patients diagnosed with labral tears and FAI or dysplasia (74 or 63 cases, respectively) through an arthroscopic procedure. Labral and concomitant cartilage injuries were evaluated. Demographics and radiological variables [lateral center-edge angle (LCEA), anterior center-edge angle, acetabular index (AI), acetabular version and alpha angle] were evaluated as risk factors for labral and cartilage injuries. Detachment of acetabular cartilage with intact labro-cartilaginous junction was the most common in dysplasia, whereas cartilage delamination from the labro-cartilaginous junction was more common in FAI (P < 0.001). A higher body mass index was significantly associated with delamination injury in FAI (odds ratio 1.226; 95% CI 1.043-1.441; P = 0.013). A significant correlation was evident between detachment injury and a larger AI in dysplasia (odds ratio 1.127; 95% CI 1.000-1.270; P = 0.049). In addition, symptom duration was positively correlated with the extent of labral tearing in FAI (P = 0.013), whereas the smaller LCEA was correlated with the larger extent of labral tearing in dysplasia (P = 0.044). FAI and dysplasia patients exhibited different labral and cartilage injury patterns. Increased body mass index was correlated with delamination injury in FAI, whereas an increased AI was associated with detachment injury in dysplasia. Greater tearing was associated with a longer symptom duration in FAI, and a decreased LCEA was a risk factor for the extent of tearing in dysplasia. Level of evidence Level III. Case-control study.

Long non-coding RNAs and microRNAs as crucial regulators in cardio-oncology.

Cancer is one of the leading causes of morbidity and mortality worldwide. Significant improvements in the modern era of anticancer therapeutic strategies have increased the survival rate of cancer patients. Unfortunately, cancer survivors have an increased risk of cardiovascular diseases, which is believed to result from anticancer therapies. The emergence of cardiovascular diseases among cancer survivors has served as the basis for establishing a novel field termed cardio-oncology. Cardio-oncology primarily focuses on investigating the underlying molecular mechanisms by which anticancer treatments lead to cardiovascular dysfunction and the development of novel cardioprotective strategies to counteract cardiotoxic effects of cancer therapies. Advances in genome biology have revealed that most of the genome is transcribed into non-coding RNAs (ncRNAs), which are recognized as being instrumental in cancer, cardiovascular health, and disease. Emerging studies have demonstrated that alterations of these ncRNAs have pathophysiological roles in multiple diseases in humans. As it relates to cardio-oncology, though, there is limited knowledge of the role of ncRNAs. In the present review, we summarize the up-to-date knowledge regarding the roles of long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) in cancer therapy-induced cardiotoxicities. Moreover, we also discuss prospective therapeutic strategies and the translational relevance of these ncRNAs.

Long-Term Results of Periacetabular Rotational Osteotomy Concomitantly With Arthroscopy in Adult Acetabular Dysplasia.

BACKGROUND: Although the long-term results of periacetabular osteotomy in acetabular dysplasia have been well documented, there is paucity in reports on the long-term outcomes of periacetabular osteotomy with simultaneous hip arthroscopy. This study aimed to assess the cumulative 10-year outcomes of periacetabular rotational osteotomy with concomitant hip arthroscopy. METHODS: Through an arthroscopic procedure, the status of the labrum was assessed, and torn labrum was debrided. Evaluations on survival from conversion to total hip arthroplasty and success in radiographic and clinical long-term results were completed in 39 hips (36 patients). Acetabular parameters (center-edge angle, Sharp angle, acetabular-head index, and head lateralization index), Tönnis grades on radiograph, Harris Hip Score, and range of motion of the hip were evaluated. Survivorship analyses were evaluated with the Kaplan-Meier method. RESULTS: Thirty-eight hips (97.4%, 95% confidence interval 0.832-0.996) were preserved for 12.8 ± 1.7 years on average, and only 1 hip was converted to total hip arthroplasty at 7.8 years. All the acetabular parameters were improved (P < .001). Twenty-eight hips (71.8%) showed unchanged or improved Tönnis grades at the latest follow-up. The average Harris Hip Score was significantly better than the preoperative value (P < .001), and range of motion was not significantly different until the latest follow-up. CONCLUSION: Sufficient acetabular reorientation, such as periacetabular rotational osteotomy, with concomitant arthroscopic debridement showed successful long-term outcomes for acetabular dysplasia in adults.

Critical differences between subtrochanteric and diaphyseal atypical femoral fractures: analyses of 51 cases at a single institution in Korean population.

There still remains controversy on the pathomechanism of atypical femoral fracture (AFF). The angle of lateral bowing and bone mineral density showed significant differences between subtrochanteric and diaphyseal atypical fracture groups. In addition to the use of bisphosphonate, mechanical factors might play important roles in the occurrence of AFFs. INTRODUCTION: Although AFF could be divided into subtrochanteric and diaphyseal fracture according to the location of fractures, there is a lack of evidence regarding differences between two fractures and etiology of the occurrence. The aim of study is to determine differences between atypical subtrochanteric and diaphyseal fracture in Korean population. METHODS: Between February 2010 and March 2015, 51 AFFs in 40 patients were included in this study. Their medical records were retrospectively reviewed. The AFF patients satisfied all the diagnostic criteria of the 2014 revised edition of the ASMBR. To analyze the differences according to the location of fracture, the AFFs were divided into subtrochanteric (n = 16) and diaphyseal (n = 35) fracture groups. The following factors were compared between two groups: patients' demographics, underlying diseases, laboratory findings (serum-25(OH) VitD3, osteocalcin, c-telopeptide, ALP, Ca, and P), bone mineral density (BMD), duration of bisphosphonate (BP) usage, and lateral bowing of the femur at time of the fracture. RESULTS: All AFFs happened in female patients (mean age, 73.8 years) who have received bisphosphonate treatments except three patients. The mean duration of bisphosphonate usage was 95.3 months. Between the two groups, demographic data (age, height, weight, and BMI), underlying diseases, laboratory findings, hip BMD, and duration of BP treatment were comparable to each other (p > 0.05). However, the subtrochanteric fracture group showed higher FNSBA (femoral neck shaft bowing angle, p < 0.001) and spine BMD (p = 0.014) compared to the diaphyseal fracture group. CONCLUSIONS: Angle of lateral bowing (FNSBA) and spine BMD showed significant differences between subtrochanteric and diaphyseal atypical fracture groups. According to our results, femoral bowing and spine BMD may play important roles in the AFF locations.

Acetabular Insufficiency Fracture Following Prolonged Alendronate Use and the Failure of Total Hip Arthroplasty in "Frozen" Bone: Two Cases Report.

Atypical insufficiency fracture of the femur following prolonged bisphosphonate use is well described. Regardless of the cause, insufficiency fracture of the acetabulum is extremely rare, and no reports have described insufficiency fractures of the acetabulum that are associated with prolonged bisphosphonate use. This report demonstrates the possibility of insufficiency fracture at the acetabulum following long-term alendronate use and the necessity of particular care in managing insufficiency fractures in "frozen" bone. We describe two cases of insufficiency fracture of the acetabulum following 6 years of alendronate use. Given the patients' medical histories and bone biopsy findings, these insufficiency fractures were thought to be attributable to alendronate use. One case involved the left hip and the presence of pelvic fractures on the opposite side. The patient was treated using cementless total hip arthroplasty (THA), which failed 1 year after surgery. The hip was revised with a massive bone graft and a supportive wire mesh. The other case was managed via THA with a Ganz reinforcement ring due to concerns regarding the use of a cementless implant.

Recurrent Hip Dislocation Following Total Hip Arthroplasty: Treatment with Sagittal Spinal Deformity Correction: A Case Report.

CASE: A 63-year-old woman with lumbar degenerative kyphosis who had undergone total hip arthroplasty 34 months previously presented after having multiple episodes of anterior hip dislocation; evaluation also revealed progressive osteoarthritis in the contralateral hip joint. The patient was managed with sagittal correction with pedicle subtraction osteotomy, which resulted in optimal positioning of the acetabular component and an upright posture. The patient had had no additional dislocation events in the involved hip and had reduced pain in the contralateral hip at the time of the 2-year follow-up. CONCLUSION: It is important to evaluate and address preexisting sagittal imbalance before performing total hip arthroplasty. However, for patients with neglected sagittal imbalance resulting in recurrent hip dislocation after total hip arthroplasty, sagittal deformity correction may be beneficial.

Quantitative analysis of tissue injury after minimally invasive total hip arthroplasty.

BACKGROUND: We intended to clarify the hypothesis that minimally invasive total hip arthroplasty (MI-THA) leads to less tissue damage and inflammatory response than does conventional total hip arthroplasty (C-THA). METHODS: We performed 30 cases of THA between September 2005 and May 2006 and evaluated these cases prospectively. We chose 15 MI-THA cases for the study group and another 15 C-THA cases for the control group. We checked skeletal muscle marker enzymes, such as serum creatinine kinase and aldolase, the pro-inflammatory cytokines, interleukin (IL)-6 and 8, and the anti-inflammatory cytokines, IL-10 and IL-1 receptor antagonist (ra) the day before surgery and at postoperative days 1, 7, and 14. RESULTS: On postoperative days 1 and 3, the study group showed significantly lower serum creatinine kinase, IL-6, IL-10, and IL-1ra values than those in the control group. Additionally, IL-8 was significantly lower on day 7 after surgery. CONCLUSIONS: These data show that MI-THA decreased the release of muscle marker enzymes due to tissue damage immediately after surgery and minimized the inflammatory response related to the surgery during the early postoperative period.

Clinical Implication of Diabetes Mellitus in Primary Total Hip Arthroplasty.

PURPOSE: The purpose of this study was to investigate the effect of diabetes mellitus on primary total hip arthroplasty by comparing the clinical outcomes of patients diagnosed to have diabetes mellitus before the operation with those without diabetes. MATERIALS AND METHODS: A total 413 patients who underwent unilateral cementless total hip arthroplasty from June 2006 to May 2009 were recruited and divided into diabetic and non-diabetic groups. The comparative analysis between the two groups was made. We evaluated Harris hip score, postoperative complications such as wound problem, surgical site infection, other medical complication and length of stay in hospital as clinical parameters. Radiographic evaluations were also included to determine loosening, dislocation and osteolysis. RESULTS: Patients with diabetes had an increased incidence of orthopaedic complications including surgical site infection and mortality, but other medical complications were not increased in diabetic patients. All complications after primary total hip arthroplasty were associated with diabetes mellitus, but the degree of diabetes was not associated with complications. CONCLUSION: Diabetes mellitus increases incidence of orthopaedic complications, particularly deep infection, after cementless primary total hip arthroplasty.

Deep vein thrombosis after total hip arthroplasty in Korean patients and D-dimer as a screening tool.

INTRODUCTION: This prospective study was designed to confirm risk factors and to assess the incidence of deep vein thrombosis after total hip and surface replacement arthroplasty in Korean patients not receiving anticoagulation prophylaxis and to determine efficacy of plasma D-dimer levels as a screening test. MATERIALS AND METHODS: From May 2003 to August 2004, 221 consecutive patients undergoing unilateral total hip arthroplasty and hip resurfacing were evaluated. All patients underwent ultrasonography preoperatively and venography and/or ultrasonography on postoperative day 7. Plasma D-dimer levels were estimated by latex immuno-assay preoperatively and on days 3 and 7 postoperatively. RESULTS: Of the 221 patients in our cohort, 23 developed deep vein thrombosis (10.4%). Age (r = 0.245, P < 0.001) and gender (r = 0.155, P = 0.021) significantly correlated with deep vein thrombosis. Rise in incidence paralleled increase in age (X(2) = 32.860, P < 0.001). D-dimer levels on postoperative days 3 (gamma = 0.364, P < 0.001) and 7 (gamma = 0.470, P < 0.001) were significantly correlated to the development of DVT. CONCLUSION: While incidence of deep vein thrombosis in Korean population after THA was lower than that in the West; it increased with age, and in female gender. Significant correlation was found between D-dimer levels and the development of deep vein thrombosis.

[Changes of the bone mineral density of proximal femur after hip resurfacing arthroplasty].

OBJECTIVE: To evaluate the changes of periprosthetic bone mineral density in femur after hip resurfacing arthroplasty. METHODS: From July 2002 to June 2005, a comparative study was carried out on 52 hips in 52 patients. Twenty-six patients (26 hips) who underwent Birmingham hip resurfacing arthroplasty (group BHR), and 26 patients (26 hips) who performed cementless total hip arthroplasty with Versys System stem (group THA). The periprosthetic bone mineral density of the femur was measured through dual energy X-ray absorptiometry of the Gruen zones at pre-operation, post-operation 3, 6, 12 and 24 months in patients from both group BHR and group THA. The bone mineral density of femoral neck in group BHR was measured too. Changes of bone mineral density ratio in proximal femur between pre-operation and post-operation were compared and analyzed. RESULTS: The mean ratio of bone mineral density of the proximal femur in group BHR reduced by 5.8%, 4.9%, 2.6% and 0.4%, in group THA reduced by 7.0%, 10.6%, 1.0% and 4.1% at 3, 6, 12 and 24 months respectively. In group BHR, the mean ratio of bone mineral density in range of interest 1 decreased to 89.7% at 6 months and increased to 103.8% at 24 months, in range of interest 7 decreased to 95.1% at 6 months and increased to 103.7% at 24 months. In group THA, the mean ratio of bone mineral density in range of interest 1 decreased to 90.8% at 6 months, 94.4% at 24 months and in range of interest 7 decreased to 94.2% at 3 months, 96.7% at 24 months. In group BHR, the bone mineral density of femoral neck was restored to the pre-operation level at 6 months. The bone mineral density in superior-lateral zone of femoral neck decreased to 97.1% at 3 months and increased to 107.4% at 24 months respectively. The bone mineral density in inferior-medial zone of femoral neck increased to 117.9% at 24 months. CONCLUSION: The bone stock of proximal femur can be well preserved and recovered quickly after hip resurfacing arthroplasty.

Effect of Betula platyphylla var. japonica on proteoglycan release, type II collagen degradation, and matrix metalloproteinase expression in rabbit articular cartilage explants.

Articular cartilage is a potential target for drugs designed to inhibit the activity of matrix metalloproteinases (MMPs) to stop or slow the destruction of proteoglycan and collagen in the cartilage extracellular matrix. The purpose of this study was to investigate the effects of Betula platyphylla var. japonica on inhibiting the release of glycosaminoglycan (GAG), the degradation of collagen, and MMP expression and activity in rabbit articular cartilage explants. Interleukin-1alpha (IL-1alpha) rapidly induced GAG, but collagen was much less readily released from cartilage explants. Betula platyphylla var. japonica significantly inhibited GAG and collagen release in a concentration-dependent manner. Betula platyphylla var. japonica dose-dependently inhibited MMP-3 and MMP-13 expression and activities from IL-1alpha-treated cartilage explant culture when tested at concentrations ranging from 0.02 to 0.2 mg/ml. Betula platyphylla var. japonica had no harmful effect on chondrocyte viability or cartilage morphology in cartilage explants. Histological analysis indicated that Betula platyphylla var. japonica reduced the degradation of the cartilage matrix compared with that of IL-1alpha-treated cartilage explants. These results indicate that Betula platyphylla var. japonica inhibits the degradation of proteoglycan and collagen through the down regulation of MMP-3 and MMP-13 expression and activities without affecting the viability or morphology of IL-1alpha-stimulated rabbit articular cartilage explants.

Influence of dietary alpha-tocopheryl acetate supplementation on cholesterol oxidation in retail packed chicken meat during refrigerated storage.

This study examined the effect of dietary alpha-tocopheryl acetate on lipid and cholesterol oxidation in retail packed chicken meat during refrigerated storage. Male broiler chicks were randomly assigned to five pens containing 30 chicks each, which was subjected to one of five dietary treatments (0, 50, 100, 200, or 400 IU of alpha-tocopheryl acetate/kg diet). Five different levels of alpha-tocopherol were supplied to the chicks from 3 to 6 weeks. After 42 d of feeding all the broilers were slaughtered, and the carcasses were packed in polyethylene bags individually, bags similar to those used in the retail trade, and stored for 12 d at 4 degrees C. Growth performance and fatty acid composition were not affected by the dietary alpha-tocopherol levels. The alpha-tocopherol content in breast and thigh muscles increased as the level of dietary alpha-tocopherol increased. The supplementation with 200 or 400 IU of alpha-tocopherol was more effective in reducing the level of lipid oxidation (P<0.05) and total cholesterol oxidation products (P<0.05). Therefore, an increase in the dietary alpha-tocopherol level from 200 to 400 IU/kg feed causes major improvements in the oxidative stability of chicken meat during refrigerated storage.

Puerariae radix promotes differentiation and mineralization in human osteoblast-like SaOS-2 cells.

Puerariae radix (PR) is a traditional medicine herb used for enhancing body resistance against various diseases. The aim of this study was to identify whether Puerariae radix extract induces osteogenic activity in human osteoblast-like SaOS-2 cells. Puerariae radix had no effect on the viability of osteoblastic cells, and dose-dependently increased alkaline phosphatase (ALP) activity. Puerariae radix markedly increased mRNA expression for vascular endothelial growth factor (VEGF), osteocalcin (OCN), osteopontin (OPN), and type I collagen (Col I) in SaOS-2 cells. Extracellular accumulation of proteins such as VEGF and Col I was increased in a dose-dependent manner. Also, Puerariae radix significantly induced mineralization in the culture of SaOS-2 cells. In conclusion, this study showed that Puerariae radix had no effect on viability, but enhanced ALP activity, VEGF, bone matrix proteins such as OCN, OPN, and Col I, and mineralization in SaOS-2 cells. These results propose that Puerariae radix can play an important role in osteoblastic bone formation, and may possibly lead to the development of bone-forming drugs.

Uncaria rhynchophylla induces angiogenesis in vitro and in vivo.

Angiogenesis consists of the proliferation, migration, and differentiation of endothelial cells, and angiogenic factors and matrix protein interactions modulate this process. The aim of this study was to determine the angiogenic properties of Uncaria rhynchophylla. Uncaria rhynchophylla significantly enhanced human umbilical vein endothelial cells (HUVECs) proliferation in a dose-dependent manner. Neutralization of vascular endothelial growth factor (VEGF) or basic fibroblast growth factor (bFGF) by monoclonal antibody suppressed the Uncaria rhynchophylla stimulatory effect on proliferation. In addition, Uncaria rhynchophylla significantly increased chemotactic-migration on gelatin and tubular structures on Matrigel of HUVECs in a dose-dependent manner. Interestingly, Uncaria rhynchophylla dose-dependently increased VEGF, and bFGF gene expression and protein secretion of HUVEC. The angiogenic activity of Uncaria rhynchophylla was confirmed using an in vivo Matrigel angiogenesis model, showing promotion of blood vessel formation. These results suggest that Uncaria rhynchophylla could potentially used to accelerate vascular wound healing or to promote the growth of collateral blood vessel in ischemic tissues.

Treatment of unstable peritrochanteric femoral fractures using a 95 degrees angled blade plate.

OBJECTIVE: To clarify the efficacy of a 95-degree angled blade plate fixation in the treatment of unstable peritrochanteric fractures of the femur. DESIGN: Retrospective, clinical study. SETTING: University hospital. PATIENTS: Thirty-nine consecutive patients with peritrochanteric femoral fractures were followed for a minimum of 12 months. There were 29 subtrochanteric fractures and 10 intertrochanteric fractures (reverse obliquity pattern) for which the compression hip screw could not be used because of comminution of the trochanteric area and fracture extension to the lateral cortex. The mean age of the patient population at the time of operation was 54 (range, 17-71) years. INTERVENTION: Open reduction and internal fixation of the pertrochanteric fractures using a 95 degrees angled blade plate. MAIN OUTCOME MEASUREMENTS: Time to fracture union, operation time, and complications. RESULTS: Duration of clinical follow-up averaged 26 (range, 12-36) months. The average time to osseous union for those fractures that healed primarily was 19 (range, 13-28) weeks. Two of 39 fractures united with 10 degrees varus deformity, but no corrective surgery was warranted. Limb length discrepancy more than 1.5 cm did not occur. Implant failure before solid bony union occurred in 1 case with a severely comminuted subtrochanteric fracture. Postoperative infection or osteonecrosis of the femoral head did not occur any time throughout the follow-up period. CONCLUSION: A 95 angled blade plate can be a useful alternative fixation device for the treatment of unstable peritrochanteric femoral fractures.

Fatty marrow conversion of the proximal femoral metaphysis in transient bone marrow edema syndrome.

INTRODUCTION: In the proximal femoral metaphysis, hematopoietic marrow is predominant during the adult stage of life. The conversion of hematopoietic marrow to fatty marrow in the proximal femoral metaphysis has been suggested as an etiologic factor of ischemia in the pathogenesis of femoral head osteonecrosis. To determine whether the chronology of fatty marrow conversion of the proximal femoral metaphysis is related to transient bone marrow edema syndrome of the hip, a case control study was conducted on 10 patients with the disease. MATERIALS AND METHODS: There were 8 men and 2 women with a mean age of 33 years (range 19-45 years). The 10 patients were matched with 20 controls for gender and age (5-year range). T1-weighted MRI scans of their hips were reviewed. Marrow of the greater trochanter becomes fatty before puberty, and thus, the greater trochanter can be used as a built-in control. The signal intensity of the proximal femoral metaphysis was compared to that of the greater trochanter. RESULTS: In all patients, the signal intensity of the proximal femoral metaphysis was isointense (fatty marrow) relative to that of the greater trochanter. In control subjects, the signal intensity was isointense in 8 (40%) and hypointense (hematopoietic marrow) in 12 (60%) (p < 0.05). CONCLUSION: The current study shows that the proximal femoral metaphysis is predominantly fatty in transient bone marrow edema syndrome. The conversion of hematopoietic to fatty marrow is known to correlate with decreases in intramedullary blood flow. Thus, the current study suggests that an ischemia of the proximal femur secondary to fatty marrow conversion of the proximal femoral metaphysis might be a cause of transient bone marrow edema syndrome of the hip.

Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity.

STUDY DESIGN: A prospective study was performed in 45 patients with ankylosing spondylitis. OBJECTIVES: To assess the outcomes of decancellation pedicle subtraction extension osteotomy in ankylosing spondylitis patients with severe fixed kyphotic deformity. SUMMARY OF BACKGROUND DATA: There have been several studies regarding correction of kyphotic deformity in ankylosing spondylitis. However, most of them concern surgical technique. There have been no reports concerning clinical results of decancellation pedicle subtraction osteotomy in ankylosing spondylitis. METHODS: The kyphotic deformity was corrected by a one-stage pedicle subtraction extension osteotomy. Radiographic assessment for sagittal balance was performed by measuring thoracic kyphosis, lumbar lordosis, distance between the vertical line on anterosuperior point of T1 and that of S1, and sacral inclination. Chin brow-vertical angle was measured on the preoperative and postoperative clinical photograph of patients. Clinical outcomes were assessed by questionnaire measuring changes in physical function, indoor activity, outdoor activity, psychosocial activity, pain, and patient satisfaction with surgery. RESULTS: Final follow-up radiograph showed an increase in lumbar lordosis from 10 degrees to 44 degrees (an increase of 34 degrees), whereas thoracic kyphosis remained stable from 50 degrees to 54 degrees. Sagittal imbalance significantly improved from 94 to 8 mm, whereas sacral inclination increased from 8 degrees to 24 degrees. The chin brow-vertical angle was 32.0 degrees before surgery and 0.9 degrees after surgery. Satisfactory clinical outcome was achieved; however, clinical improvements did not correlate with changes in radiologic measurements. CONCLUSIONS: Most of the patients maintained good correction and had good clinical results. Based on the results of this study, pedicle subtraction extension osteotomy is effective for correction of kyphotic deformity in ankylosing spondylitis.