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Sample records for head osteonecrosis model

  1. Arthroplasty in Femoral Head Osteonecrosis

    PubMed Central

    Nam, Dong Cheol; Jung, Kwangyoung

    2014-01-01

    Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head. PMID:27536561

  2. Vasculature deprivation – induced osteonecrosis of the rat femoral head as a model for therapeutic trials

    PubMed Central

    Bejar, Jacob; Peled, Eli; Boss, Jochanan H

    2005-01-01

    Experimental Osteonecrosis The authors' experience with experimentally produced femoral capital osteonecrosis in rats is reviewed: incising the periosteum at the base of the neck of the femur and cutting the ligamentum teres leads to coagulation necrosis of the epiphysis. The necrotic debris is substituted by fibrous tissue concomitantly with resorption of the dead soft and hard tissues by macrophages and osteoclasts, respectively. Progressively, the formerly necrotic epiphysis is repopulated by hematopoietic-fatty tissue, and replaced by architecturally abnormal and biomechanically weak bone. The femoral heads lose their smooth-surfaced hemispherical shape in the wake of the load transfer through the hip joint such that, together with regressive changes of the joint cartilage and inflammatory-hyperplastic changes of the articular membrane, an osteoarthritis-like disorder ensues. Therapeutic Choices Diverse therapeutic options are studied to satisfy the different opinions concerning the significance of diverse etiological and pathogenic mechanisms: 1. Exposure to hyperbaric oxygen. 2. Exposure to hyperbaric oxygen and non-weight bearing on the operated hip. 3. Medication with enoxaparin. 4. Reduction of intraosseous hypertension, putting to use a procedure aimed at core decompression, namely drilling a channel through the femoral head. 5. Medication with vascular endothelial growth factor with a view to accelerating revascularization. 6. Medication with zoledronic acid to decrease osteoclastic productivity such that the remodeling of the femoral head is slowed. Glucocorticoid-related osteonecrosis appears to be apoptosis-related, thus differing from the vessel-deprivation-induced tissue coagulation found in idiopathic osteonecrosis. The quantities of TNF-α, RANK-ligand and osteoprotegerin are raised in glucocorticoid-treated osteoblasts so that the differentiation of osteoclasts is blocked. Moreover, the osteoblasts and osteocytes of the femoral cortex mostly

  3. Experimental rat model for alcohol-induced osteonecrosis of the femoral head

    PubMed Central

    Okazaki, Shunichiro; Nagoya, Satoshi; Tateda, Kenji; Katada, Ryuichi; Mizuo, Keisuke; Watanabe, Satoshi; Yamashita, Toshihiko; Matsumoto, Hiroshi

    2013-01-01

    Alcohol-induced osteonecrosis of the femoral head (ONFH) is observed in alcohol abusers and patients with alcoholic fatty liver disease. It has been reported that Toll-like receptor 4 (TLR4) signalling plays a crucial role in the pathogenesis of alcoholic fatty liver disease. We previously reported a corticosteroid-induced ONFH rat model, and suggested that TLR4 signalling contributes to the pathogenesis of ONFH. Thus, it is thought that the pathogenesis of alcohol-induced ONFH is probably similar to that of corticosteroid-induced ONFH. The aim of this study was to develop a new animal model for alcohol-induced ONFH and to evaluate the relationship between the pro-inflammatory response via TLRs and the development of ONFH in rats. Male Wistar rats were fed a Lieber–DeCarli liquid diet containing 5% ethanol (experimental group) or dextran (control group) for 1–24 weeks. Histopathological and biochemical analyses were performed. Feeding the ethanol-containing liquid diet resulted in the development of ONFH with hepatic steatosis, hepatic dysfunction and hyperlipidaemia, whereas feeding the dextran-containing diet did not cause ONFH. However, we could not recognize any relationship between the pro-inflammatory response via TLR4 and the development of alcohol-induced ONFH. Thus in this study we have developed a new rat model for alcohol-induced ONFH based on the feeding of an ethanol liquid diet. ONFH was observed within seven days from the start of feeding with 5% ethanol-containing liquid diet. Although this was linked to hepatic steatosis, a TLR4 association was not a feature of this model. PMID:24020403

  4. Emu model of full-range femoral head osteonecrosis induced focally by an alternating freezing and heating insult.

    PubMed

    Fan, M; Peng, J; Wang, A; Zhang, L; Liu, B; Ren, Z; Xu, W; Sun, J; Xu, Lx; Xiao, D; Qin, L; Lu, S; Wang, Y; Guo, Q Y

    2011-01-01

    The emu, a large bipedal bird with hip joint biomechanics similar to humans, was used to establish an experimental model of femoral head osteonecrosis and subsequent femoral head collapse. Focal lesions were induced in 20 adult male emus using an alternating liquid nitrogen freezing and radiofrequency heating insult. At 2, 4, 8, 12 and 16 weeks post-surgery, hip magnetic resonance imaging (MRI) was performed. Before the emus were sacrificed, barium sulphate was infused to the lower extremity to study blood vessel distribution patterns. Femoral samples were scanned by micro-computed tomography (micro-CT) and evaluated histologically. Hip MRI showed changes from broad oedema to femoral head collapse. Emus developed a crippled gait from post-operative week 6. Micro-CT scans and histology showed human-like osteonecrotic changes with an impaired local blood supply. The protocol resulted in consistent full-range osteonecrosis of the femoral head that may serve as a model for testing potential treatments. PMID:21672321

  5. A canine model of osteonecrosis of the femoral head induced by MRI guided argon helium cryotherapy system

    PubMed Central

    Wang, Dong; Sun, Lixin; Zhang, Huawu; Jiang, Honglei; Liu, Ming; Tian, Jing; Hu, Na; Sun, Shui

    2015-01-01

    Objective: This study is to identify the reliability of osteonecrosis of the femoral head (ONFH) modeling established by MRI guided argon helium cryotherapy system in beagles. Methods: A total of 15 beagles were used to establish the ONFH model. The left femoral heads of the beagles received two cycles of argon helium freezing-thawing under MRI guidance and were considered as experimental group while the right femoral heads received only one cycle of argon helium freezing-thawing and were considered as the control group. X-ray, MRI, general shape and histological examinations were performed so as to identify the effect of modeling. Results: At 4 week after modeling, MRI showed obvious bilateral hip joint effusion and marked femoral head bone marrow high signal. At 8 week after surgery, abnormal signal appeared in bilateral femoral heads. T1WI showed irregular patchy low signal, T2WI showed irregular mixed signals and the joint capsule effusion showed long T1 and T2 changes. Twelve weeks after operation, T1WI showed a low signal strip with clear boundary and T2WI showed intermediate signal. The changes of the left femoral heads were significant while compared with those of the right sides. The lacunae rates of femoral heads in the experimental group at 4, 8, and 12 week after surgery (40.75 ± 3.77, 57.46 ± 4.01, 50.27 ± 2.98) were higher than those in control group (30.08 ± 3.61, 49.43 ± 2.82, 40.56 ± 2.73). Conclusion: Canine model of ONFH was successfully established using an argon helium cryotherapy system. PMID:26550205

  6. Management of femoral head osteonecrosis: Current concepts

    PubMed Central

    Tripathy, Sujit Kumar; Goyal, Tarun; Sen, Ramesh Kumar

    2015-01-01

    Osteonecrosis of femoral head (ONFH) is a disabling condition of young individuals with ill-defined etiology and pathogenesis. Remains untreated, about 70-80% of the patients progress to secondary hip arthritis. Both operative and nonoperative treatments have been described with variable success rate. Early diagnosis and treatment is the key for success in preserving the hip joint. Once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option. We reviewed 157 studies that evaluate different treatment modalities of ONFH and then a final consensus on treatment was made. PMID:25593355

  7. Rapid resolution of femoral head osteonecrosis after rotational acetabular osteotomy.

    PubMed

    Nozawa, Masahiko; Matsuda, Keiji; Maezawa, Katsuhiko; Kim, Sungon; Maeda, Kouichi; Ikegami, Takashi; Kubota, Reiko; Hayashi, Kentaro; Nagayama, Masataka; Kaneko, Haruka

    2008-12-01

    The natural history of osteonecrosis of the femoral head is generally thought to be one of progressive deterioration if no intervention is undertaken. However, it is unknown whether surgical intervention is beneficial for patients with a small region of osteonecrosis. We observed rapid improvement of MRI findings after rotational acetabular osteotomy (RAO) was performed in a young patient with osteonecrosis of the femoral head. The band-like low signal area on T2-weighted images almost resolved by six months after surgery. He returned to work as an electrician by six months after surgery. Early surgical intervention such as RAO that alters the mechanical force acting on the necrotic region of the femoral head may accelerate the recovery of osteonecrosis and the improvement of symptoms. PMID:19384490

  8. Osteonecrosis

    MedlinePlus

    Avascular necrosis; Bone infarction; Ischemic bone necrosis; AVN; Aseptic necrosis ... Osteonecrosis occurs when part of the bone does not get blood and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the joint deteriorates, leading ...

  9. Current concepts on osteonecrosis of the femoral head

    PubMed Central

    Moya-Angeler, Joaquin; Gianakos, Arianna L; Villa, Jordan C; Ni, Amelia; Lane, Joseph M

    2015-01-01

    It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated. PMID:26396935

  10. Current concepts on osteonecrosis of the femoral head.

    PubMed

    Moya-Angeler, Joaquin; Gianakos, Arianna L; Villa, Jordan C; Ni, Amelia; Lane, Joseph M

    2015-09-18

    It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated. PMID:26396935

  11. Hip replacement in femoral head osteonecrosis: current concepts

    PubMed Central

    Scaglione, Michelangelo; Fabbri, Luca; Celli, Fabio; Casella, Francesco; Guido, Giulio

    2015-01-01

    Summary Osteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patient’s factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems. PMID:27134633

  12. Biophysical stimulation in osteonecrosis of the femoral head

    PubMed Central

    Leo, Massari; Milena, Fini; Ruggero, Cadossi; Stefania, Setti; GianCarlo, Traina

    2009-01-01

    Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs) has been shown to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage. Two Italian studies on the treatment of avascular necrosis of the femoral head with PEMFs were presented in this review. In the first study, 68 patients suffering from avascular necrosis of the femoral head were treated with PEMFs in combination with core decompression and autologous bone grafts. The second one is a retrospective analysis of the results of treatment with PEMFs of 76 hips in 66 patients with osteonecrosis of the femoral head. In both studies clinical information and diagnostic imaging were collected at the beginning of the treatment and at the time of follow up. Statistical analysis was performed using chi-square test. Both authors hypothesize that the short-term effect of PEMF stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of PEMF stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. PEMF stimulation represents an important therapeutic opportunity to resolve the Ficat stage-I or II disease or at least to delay the time until joint replacement becomes necessary. PMID:19753174

  13. Osteonecrosis

    MedlinePlus

    Osteonecrosis is a disease caused by reduced blood flow to bones in the joints. In people with healthy bones, new bone is always ... arm and your knees, shoulders and ankles. The disease can affect men and women of any age, ...

  14. [Aseptic osteonecrosis of the femoral head in cancer patients with neuropathies caused by vincristine and vinblastine].

    PubMed

    Meneghello, A; Presacco, D; Di Maggio, C

    1989-06-01

    Aseptic osteonecrosis has been described in many and dissimilar pathologic conditions--most frequently as the aftermath of fractures or dislocations; in falciform anemia, obesity, alcoholism; in diseases requiring constant and heavy corticosteroid therapy, and also following renal transplantation. Many of these pathologies, especially alcoholism, diabetes, uremia, and collagen vascular diseases, have a common denominator: peripheral neuropathy, which is believed to be a pathogenetic factor supporting osteonecrosis. The authors analyze 3 cases of aseptic osteonecrosis of the femoral head in cancer patients treated with vincristine and/or vinblastine. Since in these subjects severe and persistent neuropathy preceded the onset of osteonecrosis, a possible relationship is postulated between the vincristine/vinblastine treatment and the onset of femoral head osteonecrosis, through the pathogenetic mechanism of peripheral neuropathy. PMID:2756179

  15. Osteonecrosis in patients irradiated for head and neck carcinoma

    SciTech Connect

    Morrish, R.B. Jr.; Chan, E.; Silverman, S. Jr.; Meyer, J.; Fu, K.K.; Greenspan, D.

    1981-04-15

    One hundred patients irradiated for cancers of the oral cavity, oropharynx, and nasopharynx were evaluated for the occurrence of osteonecrosis and associated predisposing factors. Selection was based on availability of complete dental records, a minimum of six months follow-up, and treatment fields, which included maxilla and/or mandible. Bone doses were calculated by using radiotherapy treatment records, port films, and isodose distributions. Osteonecrosis developed in 19 of 78 dentulous patients and in 3 of 22 edentulous patients. The time of development of osteonecrosis varied; in 15 cases osteonecrosis occurred more than one year after treatment. The most important risk factor for the development of osteonecrosis was the radiation dose to bone, particularly in the less vascular mandible. Osteonecrosis 7500 rads to the bone. None of the patients who received less than 6500 rads developed osteonecrosis. The risk was significantly greater when teeth were removed after therapy compared with those individuals with extractions before radiation or no extractions at all.

  16. Imaging evaluation of patients with osteonecrosis of the femoral head.

    PubMed

    Pierce, Todd P; Jauregui, Julio J; Cherian, Jeffrey J; Elmallah, Randa K; Mont, Michael A

    2015-09-01

    Imaging modalities for the diagnosis of osteonecrosis (ON) of the femoral head have been studied extensively, but there have been few reports strictly addressing radiographic evaluation. The purpose of this report is to examine the use and role of (1) plain radiographs, (2) magnetic resonance imaging (MRI), (3) computerized tomography (CT), (4) bone scanning, and (5) positron emission topography (PET) for the diagnostic evaluation of ON. Plain radiographs are a mainstay in diagnosis but have very low sensitivity for early ON. MRI is the gold standard for diagnostic evaluation but may not identify subchondral fractures on collapse as well as CT scan or tomogram. Bone scanning should not be used for diagnosis due to its low sensitivity. PET scanning does not have a definitive role in diagnosis yet. Future research should focus on the role of new imaging technologies in evaluation. PMID:26045084

  17. Microcrack density and nanomechanical properties in the subchondral region of the immature piglet femoral head following ischemic osteonecrosis.

    PubMed

    Aruwajoye, Olumide O; Patel, Mihir K; Allen, Matthew R; Burr, David B; Aswath, Pranesh B; Kim, Harry K W

    2013-02-01

    Development of a subchondral fracture is one of the earliest signs of structural failure of the immature femoral head following ischemic osteonecrosis, and this eventually leads to a flattening deformity of the femoral head. The mechanical and mineralization changes in the femoral head preceding subchondral fracture have not been elucidated. We hypothesized that ischemic osteonecrosis leads to early material and mechanical alterations in the bone of the subchondral region. The purpose of this investigation was to assess the bone of the subchondral region for changes in the histology of bone cells, microcrack density, mineral content, and nanoindentation properties at an early stage of ischemic osteonecrosis in a piglet model. This large animal model has been shown to develop a subchondral fracture and femoral head deformity resembling juvenile femoral head osteonecrosis. The unoperated, left femoral head of each piglet (n=8) was used as a normal control, while the right side had a surgical ischemia induced by disrupting the femoral neck vessels with a ligature. Hematoxylin and eosin (H&E) staining and TUNEL assay were performed on femoral heads from 3 piglets. Quantitative backscattered electron imaging, nanoindentation, and microcrack assessments were performed on the subchondral region of both control and ischemic femoral heads from 5 piglets. H&E staining and TUNEL assay showed extensive cell death and an absence of osteoblasts in the ischemic side compared to the normal control. Microcrack density in the ischemic side (3.2±0.79 cracks/mm(2)) was significantly higher compared to the normal side (0.27±0.27 cracks/mm(2)) in the subchondral region (p<0.05). The weighted mean of the weight percent distribution of calcium (CaMean) also was significantly higher in the ischemic subchondral region (p<0.05). Furthermore, the nanoindentation modulus within localized areas of subchondral bone was significantly increased in the ischemic side (16.8±2.7GPa) compared to the

  18. Immune response associated with Toll-like receptor 4 signaling pathway leads to steroid-induced femoral head osteonecrosis

    PubMed Central

    2014-01-01

    Background Femoral head osteonecrosis is frequently observed in patients treated with excessive corticosteroids. The objective of the current study was to establish a rat model to investigate the disruption of immune response in steroid-induced femoral head osteonecrosis via Toll-like receptor 4 (TLR4) signaling pathway. Methods Male SD rats were divided into the treatment group (group A) and the model group (group B) consisting of 24 rats each, and were injected intramuscularly with 20 mg/kg methylprednisolone (MP) for 8 weeks, once a week. The rats in group A were injected intravenously with 7.5 mg/kg TAK242 before each MP administration. A control group (group N) consisted of 12 rats were received saline injection. All animals were sacrificed 8, 10 and 12 weeks from the first MP injection, respectively. Histopathological analysis was performed and the concentration of tartrate-resistant acid phosphatase (TRAP) in serum was tested. The signaling molecules including TLR4, MyD88, NF-κB p65 and MCP-1 were detected by immunohistochemistry, quantitative real-time PCR and Western blot. Results Femoral head osteonecrosis was observed in the model rats, and the concentration of TRAP and positive staining of all signaling molecules increased significantly in group B compared with that in group A and group N. Compare with the control group, the mRNA expressions and protein levels of all signaling molecules were enhanced significantly in group B, but no significant in group A. Conclusions Corticosteroids can induce femoral head osteonecrosis by disturbing the immune response via TLR4 signaling pathway. These findings suggest that the disruption of immune response play a role in the pathogenesis of osteonecrosis. PMID:24428851

  19. Early Steroid-Induced Osteonecrosis of Rabbit Femoral Head and Panax notoginseng Saponins: Mechanism and Protective Effects

    PubMed Central

    Qiang, Hui; Liu, Huitong; Ling, Ming; Wang, Kunzheng; Zhang, Chen

    2015-01-01

    Background. This study was aimed at investigating the pathogenesis of oxidative stress in steroid-induced avascular necrosis of the femoral head (SANFH) and at exploring the mechanism and protective effects of Panax notoginseng saponins (PNS) on early SANFH. Methods. 80 adult New Zealand rabbits were randomly divided into control group, model group, and PNS group. In model group, equine serum was injected into auricular vein; then methylprednisolone was injected into gluteus. In PNS group, PNS was applied for 14 consecutive days before methylprednisolone management. At different time points, serum and femoral heads were prepared for T-AOC, SOD, GSH-PX, ·OH, and MDA determination. Two weeks after steroid management, all femoral heads were assessed with MRI and HE staining. Results. Typical early osteonecrosis symptoms were observed in model group. Our results showed that PNS could significantly ameliorate the decrease of T-AOC level, improve SOD and GSH-PX activity, suppress ·OH ability, and augment MDA level. Besides, PNS improved MRI and pathological changes of the femoral head, markedly reducing the incidence of osteonecrosis. Conclusion. Based on our research, we found oxidative stress played a positive role in the occurrence of SANFH where reactive oxygen species was the direct cause. PNS could protect rabbits against early steroid-induced osteonecrosis of femoral head by its antioxidative effect. PMID:25866538

  20. Osteonecrosis in patients irradiated for head and neck carcinoma

    SciTech Connect

    Morrish, R.B. Jr.; Chan, E.; Silverman, S. Jr.; Meyer, J.; Fu, K.K.; Greenspan, D.

    1981-04-15

    One hundred patients irradiated for cancers of the oral cavity, oropharynx, and nasopharynx were evaluated for the occurrence of osteonecrosis and associated predisposing factors. Selection was based on availability of complete dental records, a minimum of six months follow-up, and treatment fields, which included maxilla and/or mandible. Bone doses were calculated by using radiotherapy treatment records, port films, and isodose distributions. Osteonecrosis developed in 19 of 78 dentulous patients and in 3 of 22 edentulous patients. The time of development of osteonecrosis varied; in 15 cases osteonecrosis occurred more than one year after treatment. The most important risk factor for the development of osteonecrosis was the radiation dose to bone, particularly in the less vascular mandible. Osteonecrosis developed in 85% of the dentulous patients and in 50% of the edentulous patients who received more than 7500 rads to the bone. None of the patients who received less than 6500 rads developed osteonecrosis. The risk was significantly greater when teeth were removed after therapy compared with those individuals with extractions before radiation or no extractions at all.

  1. Unique plasma metabolomic signature of osteonecrosis of the femoral head.

    PubMed

    Liu, Xiaolin; Li, Qing; Sheng, Jiagen; Hu, Bin; Zhu, Zhenzhong; Zhou, Shumin; Yin, Junhui; Gong, Qiang; Wang, Yang; Zhang, Changqing

    2016-07-01

    Metabolomic analysis was performed to determine the metabolomic signature of osteonecrosis of the femoral head (ONFH), and to investigate the underlying relationship between the metabolomic signature and the pathogenesis of ONFH. Plasma samples were collected from 30 ONFH patients and 30 normal subjects. The global metabolomic profile was obtained through a combination of high-throughput liquid- and gas-chromatography-based mass spectrometry analyses. All statistical analyses were conducted using the R software. The results showed clear differences in the metabolomic signature between the plasma of ONFH patients compared with normal subjects. Among the 354 identified metabolites, the expression of 123 metabolites were significantly changed in ONFH patients compared with normal subjects (p < 0.05, q < 0.10). Bioinformatics analysis revealed that these abnormal metabolites were mainly involved in lipid-, glutathione-, nucleotide-, and energy-associated pathways, which might be related to enhanced inflammation, oxidative stress, and energy deficiency due to ONFH. This study provides the first metabolomic analysis of ONFH, and identifies a previously unrecognized metabolic signature in ONFH plasma. The results offer new insights into the pathological mechanisms of ONFH through its influence on metabolic pathways, providing the requisite framework for identifying biomarkers or novel targets for therapeutic intervention. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1158-1167, 2016. PMID:26662932

  2. Attrition tendinitis of long head of biceps brachii in relation to humeral head osteonecrosis: case report.

    PubMed

    Wiesler, Ethan R; Sarlikiotis, Thomas; Mavrogenis, Andreas F; Kokkalis, Zinon T

    2013-01-01

    This case report identifies a 41-year-old male patient who developed anterior shoulder pain in the setting of humeral head osteonecrosis. As a consequence of the cartilage degeneration, multiple loose bodies formed and migrated into the bicipital tendon sheath, causing attrition tendinitis, which was a feature of the clinical presentation. The patient was treated by a combination of arthroscopic glenohumeral joint debridement and open tenodesis of the biceps using a suture anchor. Follow-up revealed asymptomatic shoulder function by 18 months. This is the first report in the literature of bicipital tendinitis in the context of avascular necrosis of the shoulder. PMID:24063803

  3. Management of osteonecrosis of the femoral head: A novel technique

    PubMed Central

    Samy, Ahmed M

    2016-01-01

    Background: Osteonecrosis of the femoral head (ONFH) is a debilitating disease in orthopedics, frequently progressing to femoral head collapse and osteoarthritis. It is thought to be a multifactorial disease. ONFH ultimately results in femoral head collapse in 75–85% of untreated patients. Total hip arthroplasty (THA) yields satisfactory results in the treatment of the end stage of the disease. However, disease typically affects males between the ages of 20 and 40 years and joint replacement is not the ideal option for younger patients. Recently, mesenchymal stem cells and platelet rich plasma (PRP) have been used as an adjunct to core decompression to improve clinical success in the treatment of precollapse hips. Materials and Methods: A prospective study of 40 hips in 30 patients was done. There were 19 males and 11 females with a mean age 36.7 ± 6.93 years. The indication for the operation was restricted primarily to modified Ficat stages IIb and III. 16 hips (40%) had stage IIb and 24 hips (60%) had stage III ONFH. The period of follow up ranged between 36–50 months with a mean 41.4 ± 3.53 months. All patients were assessed clinically during pre- and post-operative period according to the Harris Hip Score (HHS), Visual Analog Score (VAS) and radiologically by X-rays. Magnetic resonance imaging (MRI) was done preoperatively to confirm the diagnosis and every 6 months postoperatively for assessment of healing. The operative procedure include removal of necrotic area with drilling then the cavity was filled with a composite of bone graft mixed with PRP. Results: The mean HHS improved from 46.0 ± 7.8 preoperatively to 90.28 ± 19 at the end of followup (P < 0.0001). The mean values of VAS were 78 ± 21 and 35 ± 19 at preoperatively period and final followup, respectively, with an average reduction of 43 points. Conclusion: We found that the use of PRP with collagen sheet can increase the reparable capacity after drilling of necrotic segment in stage IIb and

  4. TLR4 stimulation and corticosteroid interactively induce osteonecrosis of the femoral head in rat.

    PubMed

    Okazaki, Shunichiro; Nagoya, Satoshi; Matsumoto, Hiroshi; Mizuo, Keisuke; Shimizu, Junya; Watanabe, Satoshi; Inoue, Hiromasa; Yamashita, Toshihiko

    2016-02-01

    We previously reported that a toll-like receptor 4 signaling contributes to the development of osteonecrosis of the femoral head. Also, oxidative stress is suggested to be one of the possible pathogenesis of osteonecrosis of the femoral head. A recent study showed that toll-like receptor 4 signaling leads to oxidative stress. The aim of the present study was to evaluate whether toll-like receptor 4 stimulation and subsequent corticosteroid treatment lead to the development of osteonecrosis of the femoral head in rat, and oxidative stress is associated with it. Male Wistar rats were randomly divided into four treatment groups: Saline + Saline, Saline + Methylprednisolone, Lipopolysaccharide + Saline, Lipopolysaccharide + Methylprednisolone. Osteonecrosis of the femoral head at 14 days after the treatment was observed in 1 of 10 Lipopolysaccharide + Saline, and 5 of 10 Lipopolysaccharide + Methylprednisolone treated rats. However, it was not observed at all in the Saline + Saline and Saline + Methylprednisolone treated groups. Glutathione peroxidase activity in the liver at 1 day after the treatment was significantly increased when treated with lipopolysaccharide. However, methylprednisolone treatment reduced the activity. On the other hand, glutathione peroxidase activity in the femur did not change in any intergroup. In conclusion, the present study showed that toll-like receptor 4 stimulation by lipopolysaccharide administration strengthen incidence of corticosteroid-induced osteonecrosis of the femoral head, however, concomitant oxidative stress via toll-like receptor 4 signaling may not contribute to the development of osteonecrosis of the femoral head in rats. PMID:26249756

  5. Asparaginase Potentiates Glucocorticoid-Induced Osteonecrosis in a Mouse Model

    PubMed Central

    Liu, Chengcheng; Janke, Laura J.; Kawedia, Jitesh D.; Ramsey, Laura B.; Cai, Xiangjun; Mattano, Leonard A.; Boyd, Kelli L.; Funk, Amy J.; Relling, Mary V.

    2016-01-01

    Osteonecrosis is a common dose-limiting toxicity of glucocorticoids. Data from clinical trials suggest that other medications can increase the risk of glucocorticoid-induced osteonecrosis. Here we utilized a mouse model to study the effect of asparaginase treatment on dexamethasone-induced osteonecrosis. Mice receiving asparaginase along with dexamethasone had a higher rate of osteonecrosis than those receiving only dexamethasone after 6 weeks of treatment (44% vs. 10%, P = 0.006). Similarly, epiphyseal arteriopathy, which we have shown to be an initiating event for osteonecrosis, was observed in 58% of mice receiving asparaginase and dexamethasone compared to 17% of mice receiving dexamethasone only (P = 0.007). As in the clinic, greater exposure to asparaginase was associated with greater plasma exposure to dexamethasone (P = 0.0001). This model also recapitulated other clinical risk factors for osteonecrosis, including age at start of treatment, and association with the systemic exposure to dexamethasone (P = 0.027) and asparaginase (P = 0.036). We conclude that asparaginase can potentiate the osteonecrotic effect of glucocorticoids. PMID:26967741

  6. Asparaginase Potentiates Glucocorticoid-Induced Osteonecrosis in a Mouse Model.

    PubMed

    Liu, Chengcheng; Janke, Laura J; Kawedia, Jitesh D; Ramsey, Laura B; Cai, Xiangjun; Mattano, Leonard A; Boyd, Kelli L; Funk, Amy J; Relling, Mary V

    2016-01-01

    Osteonecrosis is a common dose-limiting toxicity of glucocorticoids. Data from clinical trials suggest that other medications can increase the risk of glucocorticoid-induced osteonecrosis. Here we utilized a mouse model to study the effect of asparaginase treatment on dexamethasone-induced osteonecrosis. Mice receiving asparaginase along with dexamethasone had a higher rate of osteonecrosis than those receiving only dexamethasone after 6 weeks of treatment (44% vs. 10%, P = 0.006). Similarly, epiphyseal arteriopathy, which we have shown to be an initiating event for osteonecrosis, was observed in 58% of mice receiving asparaginase and dexamethasone compared to 17% of mice receiving dexamethasone only (P = 0.007). As in the clinic, greater exposure to asparaginase was associated with greater plasma exposure to dexamethasone (P = 0.0001). This model also recapitulated other clinical risk factors for osteonecrosis, including age at start of treatment, and association with the systemic exposure to dexamethasone (P = 0.027) and asparaginase (P = 0.036). We conclude that asparaginase can potentiate the osteonecrotic effect of glucocorticoids. PMID:26967741

  7. Steroid-induced femoral head osteonecrosis in immune thrombocytopenia treatment with osteochondral autograft transplantation.

    PubMed

    Fotopoulos, Vasileios Ch; Mouzopoulos, George; Floros, Themistoklis; Tzurbakis, Matthaios

    2015-09-01

    Osteonecrosis of the femoral head is a devastating complication of steroid administration and has rarely been observed in the treatment of immune thrombocytopenia. The treatment of osteochondral defects in advanced stages of avascular necrosis (AVN), characterized by collapse of the subchondral bone, remains an unsolved burden in orthopedic surgery. In this report, we present a case of a 19-year-old female that was admitted in the Emergency Department with walking disability and painful hip joint movement due to steroid-induced femoral head osteonecrosis. Two years before she was diagnosed with immune thrombocytopenia, for which she received pulse steroid therapy with high dose of dexamethasone and underwent a splenectomy. This case report is the first to describe the use of osteochondral autograft transplantation as a treatment of steroid-induced AVN of the femoral head due to immune thrombocytopenia at the age of 19 years with very good clinical and radiological results 3 years postoperatively. PMID:25173503

  8. Application of bone marrow mesenchymal stem cells to the treatment of osteonecrosis of the femoral head

    PubMed Central

    Wang, Cheng; Wang, Yu; Meng, Hao-Ye; Yuan, Xue-Ling; Xu, Xiao-Long; Wang, Ai-Yuan; Guo, Quan-Yi; Peng, Jiang; Lu, Shi-Bi

    2015-01-01

    Osteonecrosis of the femoral head (ONFH) is a type of common and refractory disease in the orthopedic clinic that is primarily caused by a partial obstruction of the blood supply to the femoral head, resulting in a series of pathological processes. Mesenchymal stem cells (MSCs) comprise a mixture of various stem cells in myeloid tissue with multipotential differentiation capacity. They can differentiate into bone cells under specific conditions and can be used to treat ONFH through cell transplantation. This review summarizes research on MSCs in the field of ONFH in recent years, reveals the inner characteristics of MSCs, describes their potential to treat osteonecrosis disease, and analyzes the existing challenges of using MSCs in clinical applications. PMID:26064202

  9. Vitamin K2 Prevents Glucocorticoid-induced Osteonecrosis of the Femoral Head in Rats

    PubMed Central

    Zhang, Yue-Lei; Yin, Jun-Hui; Ding, Hao; Zhang, Wei; Zhang, Chang-Qing; Gao, You-Shui

    2016-01-01

    Glucocorticoid medication is one of the most common causes of atraumatic osteonecrosis of the femoral head (ONFH), and vitamin K2 (VK2) has been shown to play an important and beneficial role in bone metabolism. In this study, we hypothesized that VK2 could decrease the incidence of glucocorticoid-induced ONFH in a rat model. Using in vitro studies, we investigated how bone marrow-derived stem cells in the presence of methylprednisolone proliferate and differentiate, specifically examining osteogenic-related proteins, including Runx2, alkaline phosphatase and osteocalcin. Using in vivo studies, we established glucocorticoid-induced ONFH in rats and investigated the preventive effect of VK2. We employed micro-CT scanning, angiography of the femoral head, and histological and immunohistochemical analyses, which demonstrated that VK2 yielded beneficial effects for subchondral bone trabecula. In conclusion, VK2 is an effective antagonist for glucocorticoid on osteogenic progenitors. The underlying mechanisms include acceleration of BMSC propagation and promotion of bone formation-associated protein expression, which combine and contribute to the prevention of glucocorticoid-induced ONFH in rats. PMID:27019620

  10. Synergistic local drug delivery in a piglet model of ischemic osteonecrosis: a preliminary study.

    PubMed

    Zou, Yuan; Fisher, Paul D; Horstmann, Joanna K; Talwalkar, Vishwas; Milbrandt, Todd A; Puleo, David A

    2015-11-01

    A locally injectable system sequentially delivering an antiresorptive drug (clodronate) followed by an osteogenic agent (simvastatin) was hypothesized to improve femoral head microarchitecture, size, and shape compared with untreated or partial treatment groups in an established piglet osteonecrosis model. After 6 weeks, the clodronate+simvastatin treatment resulted in no collapse, microCT measurements and epiphyseal quotients within 10% of control, normal microstructure, and healthy histology. All other groups exhibited collapse, lower epiphyseal quotients and total femoral head volumes (P<0.05), and abnormal histology. This pilot study provides evidence of synergistic antiresorptive and osteogenic activities, which may prevent femoral head collapse in Perthes disease. PMID:26196370

  11. The diagnostic value of magnetic resonance imaging in non-traumatic osteonecrosis of the femoral head

    SciTech Connect

    Hauzeur, J.P.; Pasteels, J.L.; Schoutens, A.; Hinsenkamp, M.; Appelboom, T.; Chochrad, I.; Perlmutter, N.

    1989-06-01

    To assess the effectiveness of nuclear magnetic-resonance imaging in the detection of osteonecrosis of the femoral head, we studied the cases of twenty-five patients (forty-nine hips) in whom necrosis of the femoral head was suspected on the basis of plain radiographs, computed tomographic scans, radionuclide bone scans, and magnetic resonance-imaging scans. The results of these investigations were compared, for all except one patient, with the pathological findings of transtrochanteric core biopsies of the femoral head and neck of both hips. Of the forty-nine hips, thirty-three had histological proof of osteonecrosis. Twenty-two (67 per cent) of these hips showed definite necrosis on the plain radiographs; eighteen (62 per cent), on the twenty-nine available computed tomographic scans; twenty-four (77 per cent), on the thirty-one available radionuclide bone scans; and all of the hips, on the magnetic resonance-imaging studies. In six additional hips, there were histological changes (marrow necrosis, edema, hemorrhage, and fibrosis) in the medullary spaces without detectable osteonecrosis. The plain radiographs and computed tomographic scans of these six hips were normal except for the computed tomographic scan of one, and the radionuclide uptake on bone-scanning was abnormal in four of the six, as were the magnetic resonance-imaging studies. In the two hips that had normal magnetic resonance-imaging studies, the biopsies showed only destruction of fat cells in the medullary spaces, with no edema or fibroblastic reaction.

  12. Bilateral Osteonecrosis of the Femoral Head During Pregnancy Following Two Corticosteroid Injections: A Case Report and Review of the Literature

    PubMed Central

    Wood, Thomas J; Winemaker, Mitchell; Adili, Anthony

    2016-01-01

    Osteonecrosis of the femoral head during pregnancy, or shortly thereafter, is a rare clinical problem. Little is known about pregnancy as an etiological factor for femoral head osteonecrosis with only 40 reported cases in the literature. Furthermore, single or dual dose steroid-induced multifocal osteonecrosis is a controversial topic with only a handful of published cases. We present a case of a 34-year-old female with bilateral femoral head osteonecrosis that developed during the peripartum period. She received two large intramuscular injections of steroids for fetal lung maturity because early delivery was required as a result of eclampsia. She underwent total arthroplasty of the left hip due to unremitting pain and functional disability, which achieved good clinical results--relieving her pain and improving her range of motion. Literature is scarce with regard to single or dual dose steroid-induced osteonecrosis of the hip as well as pregnancy as a general etiologic factor. This case highlights the need for high clinical suspicion of osteonecrosis as a cause of postpartum hip pain.  PMID:27182470

  13. Osteonecrosis of the metatarsal head with exuberant periostitis.

    PubMed

    Mahmoud, Ines; Saidane, Olfa; Goldcher, Alain; Fautrel, Bruno; Lechevalier, Dominique

    2014-06-01

    Idiopathic necrosis of the metatarsal head is unusual in adulthood. We report five cases of an atypical necrosis of the metatarsal head with a solid periosteal reaction in adults. Different imaging features are reported and diagnosis difficulties are highlighted. PMID:24814952

  14. Porous Tantalum Implant in Treating Osteonecrosis of the Femoral Head: Still a Viable Option?

    PubMed

    Ma, Jinhui; Sun, Wei; Gao, Fuqiang; Guo, Wanshou; Wang, Yunting; Li, Zirong

    2016-01-01

    The purpose of this study is to evaluate the survivorship and risk factors for radiographic progression and conversion to total hip arthroplasty (THA) after porous tantalum implant surgery in the treatment of osteonecrosis of the femoral head (ONFH). The study comprised 90 ONFH patients (104 consecutive hips) who were treated with a porous tantalum implant combined with bone grafting between June 2008 and December 2013. The patients were 19-61 years of age (mean age, 38 years). The mean follow-up was 42 months. The outcome measures included Harris hip score (HHS), radiographic outcome measures, and survivorship analysis with conversion to THA as the endpoint. The mean postoperative HHS was significantly lower than the mean preoperative HHS (P < 0.001). The Cox proportional hazards model showed that age and Association Research Circulation Osseous (ARCO) stage were independent risk factors for conversion to THA, while age, China-Japan Friendship Hospital (CJFH) type, and ARCO stage were independent risk factors for radiological progression. Ultimately, only 52.9% hips survived. Porous tantalum implant surgery combined with bone grafting is not a viable option for treating ONFH, especially in patients >35 years of age with preoperative ARCO stage III and CJFH type L3. PMID:27324659

  15. Porous Tantalum Implant in Treating Osteonecrosis of the Femoral Head: Still a Viable Option?

    PubMed Central

    Ma, Jinhui; Sun, Wei; Gao, Fuqiang; Guo, Wanshou; Wang, Yunting; Li, Zirong

    2016-01-01

    The purpose of this study is to evaluate the survivorship and risk factors for radiographic progression and conversion to total hip arthroplasty (THA) after porous tantalum implant surgery in the treatment of osteonecrosis of the femoral head (ONFH). The study comprised 90 ONFH patients (104 consecutive hips) who were treated with a porous tantalum implant combined with bone grafting between June 2008 and December 2013. The patients were 19–61 years of age (mean age, 38 years). The mean follow-up was 42 months. The outcome measures included Harris hip score (HHS), radiographic outcome measures, and survivorship analysis with conversion to THA as the endpoint. The mean postoperative HHS was significantly lower than the mean preoperative HHS (P < 0.001). The Cox proportional hazards model showed that age and Association Research Circulation Osseous (ARCO) stage were independent risk factors for conversion to THA, while age, China-Japan Friendship Hospital (CJFH) type, and ARCO stage were independent risk factors for radiological progression. Ultimately, only 52.9% hips survived. Porous tantalum implant surgery combined with bone grafting is not a viable option for treating ONFH, especially in patients >35 years of age with preoperative ARCO stage III and CJFH type L3. PMID:27324659

  16. Bisphosphonate-modified gold nanoparticles: a useful vehicle to study the treatment of osteonecrosis of the femoral head

    NASA Astrophysics Data System (ADS)

    Fanord, Fedena; Fairbairn, Korie; Kim, Harry; Garces, Amanda; Bhethanabotla, Venkat; Gupta, Vinay K.

    2011-01-01

    Legg-Calvé-Perthes disease (LCPD) is a juvenile form of osteonecrosis of the femoral head that presents in children aged 2-14 years. To date, there is no effective medical therapy for treating LCPD largely due to an inability to modulate the repair process, including the predominance of bone resorption. This investigation aims to evaluate the feasibility of using gold nanoparticles (GNPs) that are surface modified with a bisphosphonate compound for the treatment of osteonecrosis at the cellular level. Studies have found osteoclast-mediated resorption to be a process that contributes significantly to the pathogenesis of femoral head deformities arising from Perthes disease. Our in vitro model was designed to elucidate the effect of alendronate-(a bisphosphonate) modified GNPs, on osteoclastogenesis and osteoclast function. RAW 264.7 macrophage cells were cultured with recombinant mouse receptor activator of NF-κB ligand (RANKL), which stimulates osteoclastogenesis, and were then treated with alendronate-modified GNPs for 24, 48, and 72 h. Cell proliferation, osteoclast function, and osteoclast morphology were evaluated by trypan blue dye exclusion assay, tartrate-resistant acid phosphatase (TRAP) staining, and transmission electron microscopy (TEM) imaging. Comparative studies were performed with GNPs that were only stabilized with citrate ions and with alendronate alone. Neither osteoclastogenesis nor osteoclast function were adversely affected by the presence of the citrate-GNP. Alendronate-modified GNPs had an enhanced effect on inducing osteoclast apoptosis and impairing osteoclast function when compared to unbound alendronate populations.

  17. Modified porous tantalum rod technique for the treatment of femoral head osteonecrosis

    PubMed Central

    Pakos, Emilios E; Megas, Panayiotis; Paschos, Nikolaos K; Syggelos, Spyridon A; Kouzelis, Antonios; Georgiadis, Georgios; Xenakis, Theodoros A

    2015-01-01

    AIM: To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral head. METHODS: The porous tantalum rod was combined with endoscopy, curettage, autologous bone grafting and use of bone marrow aspirates from iliac crest aspiration in 49 patients (58 hips) with a mean age of 38 years. The majority of the patients had idiopathic osteonecrosis, followed by corticosteroid-induced osteonecrosis. Thirty-eight hips were of Steinberg stage II disease and 20 hips were of stage III disease. Patients were followed for 5 years and were evaluated clinically with the Merle D’Aubigne and Postel score and radiologically. The primary outcome of the study was survival based on the conversion to total hip arthroplasty (THA). Secondary outcomes included deterioration of the osteonecrosis to a higher disease stage at 5 years compared to the preoperative period and identification of factors that were associated with survival. The Kaplan-Meier survival analysis was performed to evaluate the survivorship of the prosthesis, and the Fisher exact test was performed to test associations between various parameters with survival. RESULTS: No patient developed any serious intraoperative or postoperative complication including implant loosening or migration and donor site morbidity. During the 5-year follow up, 1 patient died, 7 patients had disease progression and 4 hips were converted to THA. The 5-year survival based on conversion to THA was 93.1% and the respective rate based on disease progression was 87.9%. Stage II disease was associated with statistically significant better survival rates compared to stage III disease (P = 0.04). The comparison between idiopathic and non-idiopathic osteonecrosis and between steroid-induced and non-steroid-induced osteonecrosis did not showed any statistically significant difference in survival rates. The clinical evaluation revealed statistically significantly improved Merle d’Aubigne scores at 12 mo postoperatively

  18. Circulating exosome levels in the diagnosis of steroid-induced osteonecrosis of the femoral head

    PubMed Central

    Zhu, H-Y.; Gao, Y-C.; Wang, Y.

    2016-01-01

    Objectives Circulating exosomes represent novel biomarkers for multiple diseases. In this study, we investigated whether circulating exosome levels could be used as a diagnostic biomarker for steroid-induced osteonecrosis of the femoral head (ONFH). Methods We assessed the serum exosome level of 85 patients with steroid-induced ONFH and 115 healthy donors by Nanosight detection. We then assessed the diagnostic accuracy of serum exosomes by receiver operating characteristic curve analysis. Results The circulating exosome level of the ONFH group was significantly lower than that of control group. The area under the curve was 0.72, suggesting that the level of serum exosomes has moderate diagnostic accuracy for steroid-induced ONFH. Conclusion Circulating exosome levels are valuable in the diagnosis of steroid-induced ONFH. Cite this article: H-Y. Zhu, Y-C. Gao, Y. Wang, C-Q. Zhang. Circulating exosome levels in the diagnosis of steroid-induced osteonecrosis of the femoral head. Bone Joint Res 2016;5:276–279. DOI: 10.1302/2046-3758.56.BJR-2015-0014.R1. PMID:27357384

  19. Osteonecrosis of the Femoral Head in the Setting of a Complex Acetabulum Fracture without Hip Dislocation Treated Surgically Using Ilio-inguinal Approach: A Case Report

    PubMed Central

    Sobti, Anshul Shyam

    2014-01-01

    Osteonecrosis in isolated fractures of the acetabulum without dislocation of hip seems to be a known complication, but to our knowledge it has not been reported adequately. The causative nature of post-traumatic femoral head osteonecrosis has not been studied critically. The pathophysiology of osteonecrosis in this case also eludes us. Striking evidence points towards the intra-operative blood loss and low mean arterial pressure possibly leading to hypo-perfusion of femoral head leading to osteonecrosis. Fractures of the acetabulum pose a difficult problem for the patient and the surgeon because of possible complications. Thus any surgeon involved in surgery for fractures of the acetabulum should be aware of the possibility of this potential complication. Here is a 61-year male, who sustained a complex fracture of the acetabulum without hip dislocation, subsequently was treated surgically with internal fixation using an anterior approach, 10 months after surgery patient developed osteonecrosis of the femoral head.

  20. Conservative surgery for the treatment of osteonecrosis of the femoral head: current options

    PubMed Central

    Gasbarra, Elena; Perrone, Fabio Luigi; Baldi, Jacopo; Bilotta, Vincenzo; Moretti, Antimo; Tarantino, Umbertto

    2015-01-01

    Summary The prevention of femoral head collapse and the maintenance of hip function would represent a substantial achievement in the treatment of osteonecrosis of the femoral head; however it is difficult to identify appropriate treatment protocols to manage patients with pre-collapse avascular necrosis in order to obtain a successful outcome in joint preserving procedures. Conservative treatments, including pharmacological management and biophysical modalities, are not supported by any evidence and require further investigation. The appropriate therapeutic approach has not been identified. The choice of surgical procedures is based on patient clinical conditions and anatomopathological features; preservation of the femoral head by core decompression may be attempted in younger patients without head collapse. Biological factors, such as bone morphogenetic proteins and bone marrow stem cells, would improve the outcome of core decompression. Another surgical procedure proposed for the treatment of avascular necrosis consists of large vascularized cortical bone grafts, but its use is not yet common due to surgical technical issues. Use of other surgical technique, such as osteotomies, is controversial, since arthroplasty is considered as the first option in case of severe femoral head collapse without previous intervention. PMID:27134632

  1. Vitamin K2 Ameliorates Damage of Blood Vessels by Glucocorticoid: a Potential Mechanism for Its Protective Effects in Glucocorticoid-induced Osteonecrosis of the Femoral Head in a Rat Model

    PubMed Central

    Zhang, Yuelei; Yin, Junhui; Ding, Hao; Zhang, Changqing; Gao, You-Shui

    2016-01-01

    Glucocorticoid has been reported to decrease blood vessel number and harm the blood supply in the femoral head, which is recognized to be an important mechanism of glucocorticoid-induced osteonecrosis of the femoral head (ONFH). To prevent glucocorticoid-induced ONFH, medication that promotes both bone formation and angiogenesis would be ideal. Vitamin K2 has been revealed to play an important role in bone metabolism; however, few studies have focused on the effect of Vitamin K2 on new vascular formation. Thus, this study aimed to investigate whether Vitamin K2 promoted new blood vessel formation in the presence of glucocorticoids, both in vitro and in vivo. The effect of Vitamin K2 on viability, migration, in vitro tube formation, and VEGF, vWF, CD31, KDR, Flt and PDGFB in EAhy926 incubated with or without dexamethasone were elucidated. VEGF, TGF-β and BMP-2, angiogenesis-related proteins secreted by osteoblasts, were also detected in the osteoblast-like cell line of MG63. In addition, blood vessels of the femoral head in rats administered with or without methylprednisolone and Vitamin K2 were evaluated using angiography and CD31 staining. In vitro studies showed that Vitamin K2 significantly protected endothelial cells from dexamethasone-induced apoptosis, promoted endothelial cell migration and in vitro tube formation. Angiogenesis-related proteins both in EAhy926 and MG63 were also upregulated by Vitamin K2 when cotreated with dexamethasone. In vivo studies showed enhanced blood vessel volume and CD31-positive staining cells in rats cotreated with VK2 and methylprednisolone compared to rats treated with methylprednisolone only. Collectively, Vitamin K2 has the ability to promote angiogenesis in vitro and to ameliorate vessels of the femoral head in glucocorticoid-treated rats in vivo, indicating that Vitamin K2 is a promising drug that may be used to prevent steroid-induced ONFH. PMID:27313492

  2. Surgical management of osteonecrosis of the femoral head in patients with sickle cell disease

    PubMed Central

    Kamath, Atul F; McGraw, Michael H; Israelite, Craig L

    2015-01-01

    Sickle cell disease is a known risk factor for osteonecrosis of the hip. Necrosis within the femoral head may cause severe pain, functional limitations, and compromise quality of life in this patient population. Early stages of avascular necrosis of the hip may be managed surgically with core decompression with or without autologous bone grafting. Total hip arthroplasty is the mainstay of treatment of advanced stages of the disease in patients who have intractable pain and are medically fit to undergo the procedure. The management of hip pathology in sickle cell disease presents numerous medical and surgical challenges, and the careful perioperative management of patients is mandatory. Although there is an increased risk of medical and surgical complications in patients with sickle cell disease, total hip arthroplasty can provide substantial relief of pain and improvement of function in the appropriately selected patient. PMID:26601059

  3. Surgical management of osteonecrosis of the femoral head in patients with sickle cell disease.

    PubMed

    Kamath, Atul F; McGraw, Michael H; Israelite, Craig L

    2015-11-18

    Sickle cell disease is a known risk factor for osteonecrosis of the hip. Necrosis within the femoral head may cause severe pain, functional limitations, and compromise quality of life in this patient population. Early stages of avascular necrosis of the hip may be managed surgically with core decompression with or without autologous bone grafting. Total hip arthroplasty is the mainstay of treatment of advanced stages of the disease in patients who have intractable pain and are medically fit to undergo the procedure. The management of hip pathology in sickle cell disease presents numerous medical and surgical challenges, and the careful perioperative management of patients is mandatory. Although there is an increased risk of medical and surgical complications in patients with sickle cell disease, total hip arthroplasty can provide substantial relief of pain and improvement of function in the appropriately selected patient. PMID:26601059

  4. A current review of non-vascularized bone grafting in osteonecrosis of the femoral head.

    PubMed

    Pierce, Todd P; Elmallah, Randa K; Jauregui, Julio J; Poola, Shiva; Mont, Michael A; Delanois, Ronald E

    2015-09-01

    Over the past three decades, non-vascularized bone grafts have been demonstrated to be viable treatments for pre- and early post-collapse osteonecrosis of the femoral head; however, there are limited reviews on this topic. Therefore, the purposes of this review are to (1) provide a summary of the different surgical techniques and their respective clinical outcomes and (2) evaluate new adjunct therapies. Originally, non-vascularized bone grafting was performed using the Phemister technique with varying results. More recently, newer techniques such as the lightbulb and trapdoor are used to place non-vascularized bone grafts with excellent results. The addition of various biological agents has demonstrated positive results; however, further studies are needed to confirm the best appropriate indications and to elucidate long-term results. PMID:26009009

  5. Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis

    PubMed Central

    Varitimidis, Sokratis E; Dimitroulias, Apostolos P; Karachalios, Theophilos S; Dailiana, Zoe H

    2009-01-01

    Background and purpose Tantalum rod implantation has recently been proposed for treatment of early stages of femoral head osteonecrosis. The purpose of our study was to report the early results of its use in pre- and post-collapse stages of the disease. Methods We studied prospectively 27 patients who underwent tantalum rod implantation for treatment of nontraumatic femoral head osteonecrosis between December 2000 and September 2005. Patients were evaluated radiologically and clinically using the Steinberg classification and the Harris hip score (HHS). Disease stage varied between stages II and IV. Mean follow-up time was 38 (15–71) months. Results 1 patient (1 hip) died 15 months after surgery for reasons unrelated to it. 13 of 26 hips remained at the same radiographic stage, and 13 deteriorated. Mean HHS improved from 49 to 85. 6 patients required conversion to total hip arthroplasty. When the procedure was used for stages III and IV, both radiological outcome and revision rates were worse than for the stage II hips. There was, however, no difference in postoperative HHS between patients at pre- and post-collapse stages at the time of initial evaluation. Survivorship, with revision to THA as the endpoint, was 70% at 6 years. Interpretation The disease process does not appear to be interrupted, but there was a significant improvement in hip function initially in most hips. Tantalum rod implantation is a safe “buy-time” technique, especially when other joint salvage procedures are not an option. Appropriate patient selection and careful rod insertion are needed for favorable results. PMID:19297785

  6. 3D segmentation and quantification of magnetic resonance data: application to the osteonecrosis of the femoral head

    NASA Astrophysics Data System (ADS)

    Klifa, Catherine S.; Lynch, John A.; Zaim, Souhil; Genant, Harry K.

    1999-05-01

    The general objective of our study is the development of a clinically robust three-dimensional segmentation and quantification technique of Magnetic Resonance (MR) data, for the objective and quantitative evaluation of the osteonecrosis (ON) of the femoral head. This method will help evaluate the effects of joint preserving treatments for femoral head osteonecrosis from MR data. The disease is characterized by tissue changes (death of bone and marrow cells) within the weight-bearing portion of the femoral head. Due to the fuzzy appearance of lesion tissues and their different intensity patterns in various MR sequences, we proposed a semi-automatic multispectral segmentation of MR data introducing data constraints (anatomical and geometrical) and using a classical K-means unsupervised clustering algorithm. The method was applied on ON patient data. Results of volumetric measurements and configuration of various tissues obtained with the semi- automatic method were compared with quantitative results delineated by a trained radiologist.

  7. [Is instillation of bone marrow stem cells at the time of core decompression useful for osteonecrosis of the femoral head?].

    PubMed

    Cabrolier, Jorge; Molina, Marcelo

    2016-01-01

    Osteonecrosis of the femoral head leads to degeneration of the head and finally to osteoarthritis of the hip. Decompression is the most widely used treatment, but its effectiveness is limited. It has been proposed instillation of stem cells in addition to decompression, would lead to better results. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including two randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded instillation of bone marrow stem cells at the time of core decompression probably slows progression to osteoarthritis of the hip in patients with osteonecrosis of the femoral head and might reduce the need of subsequent surgeries. It is unclear whether it has any effect on the functionality because the certainty of the evidence is very low. PMID:27028230

  8. Failed vascularized fibular graft in treatment of osteonecrosis of the femoral head. A histopathological analysis

    PubMed Central

    MELONI, MARIA CHIARA; HOEDEMAEKER, W. RUSSALKA; FORNASIER, VICTOR

    2016-01-01

    Purpose vascularized fibular grafting has been used to treat osteonecrosis of the femoral head in younger patients. Although the results described in the literature are promising, the failure rate is still significant, especially in steroid users. This study was undertaken to learn more, on a histopathological level, about the mechanism of vascularized fibular graft failure. Methods fifteen femoral heads removed at conversion to total hip arthroplasty were analyzed. The case load comprised 10 men and 5 women. They ranged in age from 28 to 39 years and had a median age of 35 years. The interval between the vascularized fibular implant procedure and the conversion to total hip arthroplasty ranged from 22 months to 30 months; the median interval was 26 months. All the patients were steroid users. The heads were sectioned and axial and coronal sections were taken and stained using the WHO method (hematoxylin, phloxine, saffron and Alcian green). A quantitative and qualitative analysis of graft-host interaction at the head (zone 1), neck (zone 2) and epiphysis (zone 3) was performed. Results all the specimens showed recognizable collapse of the articular surface over the area of necrosis. Thirteen femoral heads showed the presence of an osteochondral flap attached only at the margins of the area of avascular necrosis, and 10 of these 13 femoral heads also showed loss of the articulating surface with an ulcer crater corresponding to the exposed area of avascular necrosis. Conclusions vascularized fibular graft failure seems to be related to a negative effect of creeping substitution: the revascularization becomes a negative force as it supports unbalanced bone resorption, which, as is well known, is enhanced by corticosteroids. Clinical relevance creeping substitution is an undermining force in the repair and revascularization of the necrotic area in the femoral head. PMID:27386444

  9. Experimental osteonecrosis: development of a model in rodents administered alendronate.

    PubMed

    Conte, Nicolau; Spolidorio, Luis Carlos; Andrade, Cleverton Roberto de; Esteves, Jônatas Caldeira; Marcantonio, Elcio

    2016-01-01

    The main objective of this study was to cause bisphosphonate-related osteonecrosis of the jaws to develop in a rodent model. Adult male Holtzman rats were assigned to one of two experimental groups to receive alendronate (AL; 1 mg/kg/week; n = 6) or saline solution (CTL; n = 6). After 60 days of drug therapy, all animals were subjected to first lower molar extraction, and 28 days later, animals were euthanized. All rats treated with alendronate developed osteonecrosis, presenting as ulcers and necrotic bone, associated with a significant infection process, especially at the inter-alveolar septum area and crestal regions. The degree of vascularization, the levels of C-telopeptide cross-linked collagen type I and bone-specific alkaline phosphatase, as well as the bone volume were significantly reduced in these animals. Furthermore, on radiographic analysis, animals treated with alendronate presented evident sclerosis of the lamina dura of the lower first molar alveolar socket associated with decreased radiographic density in this area. These findings indicate that the protocol developed in the present study opens new perspectives and could be a good starting model for future property design. PMID:27556684

  10. Preclinical Study of Cell Therapy for Osteonecrosis of the Femoral Head with Allogenic Peripheral Blood-Derived Mesenchymal Stem Cells

    PubMed Central

    Fu, Qiang; Tang, Ning-Ning; Zhang, Qian; Liu, Yi; Peng, Jia-Chen; Fang, Ning; Yu, Li-Mei; Liu, Jin-Wei

    2016-01-01

    Purpose To explore the value of transplanting peripheral blood-derived mesenchymal stem cells from allogenic rabbits (rPBMSCs) to treat osteonecrosis of the femoral head (ONFH). Materials and Methods rPBMSCs were separated/cultured from peripheral blood after granulocyte colony-stimulating factor mobilization. Afterwards, mobilized rPBMSCs from a second passage labeled with PKH26 were transplanted into rabbit ONFH models, which were established by liquid nitrogen freezing, to observe the effect of rPBMSCs on ONFH repair. Then, the mRNA expressions of BMP-2 and PPAR-γ in the femoral head were assessed by RT-PCR. Results After mobilization, the cultured rPBMSCs expressed mesenchymal markers of CD90, CD44, CD29, and CD105, but failed to express CD45, CD14, and CD34. The colony forming efficiency of mobilized rPBMSCs ranged from 2.8 to 10.8 per million peripheral mononuclear cells. After local transplantation, survival of the engrafted cells reached at least 8 weeks. Therein, BMP-2 was up-regulated, while PPAR-γ mRNA was down-regulated. Additionally, bone density and bone trabeculae tended to increase gradually. Conclusion We confirmed that local transplantation of rPBMSCs benefits ONFH treatment and that the beneficial effects are related to the up-regulation of BMP-2 expression and the down-regulation of PPAR-γ expression. PMID:27189298

  11. Efficacy of Alendronate for Preventing Collapse of Femoral Head in Adult Patients with Nontraumatic Osteonecrosis

    PubMed Central

    Hong, Yu-Cai; Luo, Ru-Bin; Zhong, Hui-Ming; Shi, Jian-Bin

    2014-01-01

    The purpose of the current review was to determine the efficacy of alendronate for preventing collapse of femoral head in adult patients with nontraumatic avascular osteonecrosis of femoral head (ANFH). Five randomized controlled trials (RCTs) involving 305 hips were included in this review, of which 3 studies investigated alendronate versus control/placebo and the other 2 studies compared the combination of alendronate and extracorporeal shockwave therapy (ESWT) with ESWT alone. Our results suggested that even the patients with extensive necrosis encountered much less collapse in the alendronate group than control group. In these RCTs, their data also indicated a positive short- and middle-term efficacy of alendronate treatment in joint function improvement and hip pain diminishment. With the presence of the outlier study, only insignificant overall efficacy of alendronate could be observed with substantial heterogeneities. In addition, we did not find any additive benefits of alendronate in combination with ESWT for preventing collapse compared to ESWT alone. In conclusion, there is still lack of strong evidence for supporting application of alendronate in adult patients with nontraumatic ANFH, which justified that large scale, randomized, and double-blind studies should be developed to demonstrate the confirmed efficacies, detailed indication, and optimized strategy of alendronate treatment. PMID:25535614

  12. [Study of circulating fatty globules by filtration of the serum in primary osteonecrosis of the femoral head].

    PubMed

    Roux, H; Serratrice, G; Vovan, L; Savidan-Imbert

    1979-12-01

    The authors carried out in a group of 21 aseptic osteonecroses of the femoral head, a study of circulating fatty globules using a filtering technique on a millipore filter. 7 of these patients showed a normal lipid count, 10 had isolated increases of the prebetalipoproteins, 2 had a type IV hyperlipemia, 1 a type III hyperlipemia, and 1 a global hypolipemia. In all cases, no fatty globules were found. Decreases in the level of triglycerides and prebetalipoproteins were noted after filtering but the differences were not significant. These observations do not add support to the theory of fatty microembolism of aseptic osteonecrosis of the femoral head. PMID:531470

  13. Relation between osteonecrosis of the femoral head and PAI-1 4G/5G gene polymorphism: a meta-analysis

    PubMed Central

    Zeng, Zheng; Wang, Bing; Pan, Haitao

    2015-01-01

    Objective: The aim of this study was to investigate the association of plasminogen activator inhibitor-1 (PAI-1) 4G/5G gene polymorphism and osteonecrosis of the femoral head (ONFH). Methods: The pooled relative risk ratio (RR) and 95% confidence intervals (95% CI) were calculated using the the RevMan 5.0 software. Results: The present study included 969 patients with ONFH and 419 healthy controls. The Meta analysis results showed: There is association between PAI-1 gene 4G/5G polymorphism and the increasing risk of ONFH (allele model: RR = 1.24, 95% CI = 1.16 ~ 1.33; dominant genetic model: RR = 1.12, 95% CI = 1.05 ~ 1.18). It was found that the association between PAI-1 gene 4 G/5 G polymorphism and the susceptibility of ONFH (P < 0.05) through the comparison of Caucasian population and Asian people according to the analysis of different races. Conclusions: There is association between PAI-1 gene 4 G/5 G polymorphism and the increasing of the susceptibility of ONFH. PMID:26884949

  14. Bilateral non-traumatic aseptic osteonecrosis in the femoral head. An experimental study of incidence

    SciTech Connect

    Hauzeur, J.P.; Pasteels, J.L.; Orloff, S.

    1987-10-01

    Thirty-five patients who were seen with non-traumatic aseptic osteonecrosis of the femoral head were included in a study of the contralateral hip to evaluate the incidence of bilateral disease. We used not only conventional radiography and scintigraphy but also measurement of intramedullary pressure and core biopsy. Pain was caused by 14.3 per cent of the contralateral hips, a lesion was demonstrated on plain radiographs in 51.4 per cent, and increased isotopic uptake was seen in 31.4 per cent. Histological study of specimens obtained by osteomedullary biopsy (after special procedure) showed bilateral necrosis in 88.5 per cent of the patients. After a mean follow-up of thirty-four months, only one of nine hips that were painless and had negative radiographic and isotopic findings, but had positive findings on biopsy, became painful and radiographically positive. The intramedullary pressure in the intertrochanteric area was recorded in each hip, and no correlation was found with the radiographic stage or with pain.

  15. Involvement of MicroRNA-210 Demethylation in Steroid-associated Osteonecrosis of the Femoral Head

    PubMed Central

    Yuan, Heng-feng; Christina, Von Roemeling; Guo, Chang-an; Chu, Yi-wei; Liu, Rong-hua; Yan, Zuo-qin

    2016-01-01

    Angiogenesis is an important event in steroid-associated osteonecrosis of the femoral head (SONFH). Here we performed miRNA microarray with SONFH tissues (ONs) and the adjacent normal tissues (NLs) to select the angiogenic miRNA. The results showed that miR-210 was differentially expressed in SONFH versus normal tissues. Unexpectedly, its specific transcription factor, hypoxia-inducible factor-1α, was shown of no significant changes in ONs compared with NLs. Further Bisulfite sequencing revealed that miR-210 is embedded in a CpG island and miR-210 gene has 2 CpG sites with lower methylation percentage in ONs compared with NLs. Additionally, ONs with lower miR-210 gene methylation exhibited higher miR-210 expression. Next, we found that the endothelial cells treated with demethylating agents could significantly increase the expression of miR-210, along with promoted cell viability and differentiation. Some angiogenic genes (VEGF, bFGF, TNF-α and PCNA) were up-regulated as well. In addition, the supernatant of the cells after demethylation treatment displayed an enhanced ability of recruiting new microvessels in vivo. Taken together, our study not only provides novel insights into the regulation of angiogenesis in this disease, but also reveals a therapeutic opportunity for treatment of SONFH patients with demethylating agents. PMID:26805628

  16. Association of Complement Receptor 2 Gene Polymorphisms with Susceptibility to Osteonecrosis of the Femoral Head in Systemic Lupus Erythematosus

    PubMed Central

    Kim, Tae-Ho; Bae, Sang-Cheol; Lee, Sang-Han; Kim, Shin-Yoon

    2016-01-01

    Osteonecrosis of the femoral head (ONFH) is a complex and multifactorial disease that is influenced by a number of genetic factors in addition to environmental factors. Some autoimmune disorders, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD), are associated with the development of ONFH. Complement receptor type 2 (CR2) is membrane glycoprotein which binds C3 degradation products generated during complement activation. CR2 has many important functions in normal immunity and is assumed to play a role in the development of autoimmune disease. We investigated whether CR2 gene polymorphisms are associated with risk of ONFH in SLE patients. Eight polymorphisms in the CR2 gene were genotyped using TaqMan™ assays in 150 SLE patients and 50 ONFH in SLE patients (SLE_ONFH). The association analysis of genotyped SNPs and haplotypes was performed with ONFH. It was found that three SNPs, rs3813946 in 5′-UTR (untranslated region), rs311306 in intron 1, and rs17615 in exon 10 (nonsynonymous SNP; G/A, Ser639Asn) of the CR2 gene, were associated with an increased risk of ONFH under recessive model (P values; 0.004~0.016). Haplotypes were also associated with an increased risk (OR; 3.73~) of ONFH in SLE patients. These findings may provide evidences that CR2 contributes to human ONFH susceptibility in Korean SLE patients. PMID:27446959

  17. Protective effect of genistein aglycone on the development of osteonecrosis of the femoral head and secondary osteoporosis induced by methylprednisolone in rats.

    PubMed

    Bitto, Alessandra; Polito, Francesca; Burnett, Bruce; Levy, Robert; Di Stefano, Vincenzo; Armbruster, Mary Ann; Marini, Herbert; Minutoli, Letteria; Altavilla, Domenica; Squadrito, Francesco

    2009-06-01

    Glucocorticoid (GC)-induced osteoporosis (GIO) is the most important secondary cause of bone loss. Clinical evidence suggests a role for genistein (GEN) aglycone in the prevention of osteoporosis. We investigated whether GEN could prevent GIO as well as the development of osteonecrosis in the femoral head using an experimental rat model. A total of 28 female Sprague-Dawley rats were used in the study. GIO and osteonecrosis were induced by daily s.c. injections of 30 mg/kg of methylprednisolone (MP; n=7). Another group of animals (MP+GEN; n=7) concomitantly received MP (30 mg/kg per s.c.) and GEN aglycone (5 mg/kg per i.p.) for 60 days. Control animals were administered daily with vehicle (VEH) or GEN (5 mg/kg per i.p.) only. At the beginning and end of the treatment, animals were examined for bone mineral density (BMD) and bone mineral content (BMC). After killing, serum was collected to determine bone-alkaline phosphatase (b-ALP), carboxy-terminal collagen crosslink (CTX) and osteoprotegerin (OPG) levels. Femurs were removed and tested for breaking strength and bone histology analyzed for structural quality of the femoral neck. GEN aglycone prevented bone loss as measured by BMD and BMC. Moreover, GEN significantly increased the bone formation markers b-ALP and OPG, reduced the bone resorption marker CTX and statistically maintained comparable strength versus the VEH only group. Finally, histological scoring revealed a protective effect of GEN on bone structure statistically comparable with the VEH control animals. Results suggest that the GEN aglycone might be a preventive treatment for GIO and complications of osteonecrosis with long-term GC treatment. PMID:19332450

  18. Arthroscopic correction for concomitant cam impingement in a patient with idiopathic osteonecrosis of the femoral head: A case report

    PubMed Central

    Fukui, Kiyokazu; Kaneuji, Ayumi; Matsumoto, Tadami

    2015-01-01

    A 53-year-old man presented with pain in the right hip. Radiological examination showed idiopathic osteonecrosis of the femoral head (ONFH) combined with a cam lesion. Findings on physical examination were consistent for femoroacetabular impingement. At surgery, we performed isolated arthroscopic correction for the cam lesion but did not use other treatment options such as hip arthroplasty or osteotomies for the ONFH. At the latest follow-up evaluation 3 years after surgery, findings indicted a satisfactory outcome, with a Harris hip score of 93.2 (compared with 76.4 before surgery), no joint-space narrowing, and no collapse of the femoral head. It is important to accurately diagnose the status of idiopathic ONFH and to consider another possible pathogenesis when a patient with idiopathic ONFH has hip pain even without femoral-head collapse. PMID:26773875

  19. Invasive Electromagnetic Field Treatment in Osteonecrosis of the Femoral Head: A Prospective Cohort Study

    PubMed Central

    Windisch, C.; Kolb, W.; Röhner, E.; Wagner, M.; Roth, A.; Matziolis, G.; Wagner, A.

    2014-01-01

    Introduction : The purpose of this prospective cohort study was to compare the surgical treatment of non-ONFH in adulthood by curettage and bone grafting with treatment by curettage and bone grafting in combination with invasive electromagnetic field treatment using Magnetodyn®. This was assessed by examining whether electromagnetic field treatment has a positive additive effect on the clinical parameters modified Harris Hip Score according to Haddad, Cook and Brinker, Merle d'Aubigné hip score and visual analogue scale, and on the subsequent need for treatment by total hip arthroplasty. Materials and Methodology : The prospective, non-randomised study included 35 patients with unilateral or bilateral osteonecrosis of the femoral head. These were divided into two groups according to the surgical treatment regime and assessed over a 12-month follow-up period. The study group (Group 1) comprised 19 patients (14 men and 5 women) with a total of 22 non-ONFH, who underwent minimally invasive curettage, bone grafting and electromagnetic field treatment (Magnetodyn®) by implantation of a bipolar induction screw. The control group (Group 2) comprised 16 patients (12 men and 4 women) with a total of 18 non-ONFH, who underwent minimally invasive curettage and bone grafting without Magnetodyn® therapy. At the initial pre-operative examination and the 6 and 12-month follow-up, all patients were assessed by clinical examination and radiological monitoring, and by bilateral hip MRI. The clinical evaluation was based on the modified Harris Hip Score according to Haddad, Cook and Brinker, the Merle d`Aubigné hip score and the visual analogue scale (VAS). Results : At the time of follow-up, total hip arthroplasty (THA) had been performed in four patients in Group 1 (18%). In Group 2, four patients (22%) had received a THA (n.s.). Both procedures led to an improvement in the clinical scores (Harris Hip Score, Merle d`Aubigné score and VAS), although no significant difference

  20. MiR-708 promotes steroid-induced osteonecrosis of femoral head, suppresses osteogenic differentiation by targeting SMAD3

    PubMed Central

    Hao, Cheng; Yang, Shuhua; Xu, Weihua; Shen, Jacson K.; Ye, Shunan; Liu, Xianzhe; Dong, Zhe; Xiao, Baojun; Feng, Yong

    2016-01-01

    Steroid-induced osteonecrosis of femoral head (ONFH) is a serious complication of glucocorticoid (GC) use. We investigated the differential expression of miRs in the mesenchymal stem cells (MSCs) of patients with ONFH, and aimed to explain the relationship between GC use and the development of MSC dysfunction in ONFH. Cells were collected from bone marrow of patients with ONFH. Samples were assigned to either GCs Group or Control Group at 1:1 matched with control. We then used miRNA microarray analysis and real-time PCR to identify the differentially expressed miRs. We also induced normal MSCs with GCs to verify the differential expression above. Subsequently, we selected some of the miRs for further studies, including miRNA target and pathway prediction, and functional analysis. We discovered that miR-708 was upregulated in ONFH patients and GC-treated MSCs. SMAD3 was identified as a direct target gene of miR-708, and functional analysis demonstrated that miR-708 could markedly suppress osteogenic differentiation and adipogenesis differentiation of MSCs. Inhibition of miR-708 rescued the suppressive effect of GC on osteonecrosis. Therefore, we determined that GC use resulted in overexpression of miR-708 in MSCs, and thus, targeting miR-708 may serve as a novel therapeutic biomarker for the prevention and treatment of ONFH. PMID:26932538

  1. Free vascularized fibular grafts for femoral head osteonecrosis: alternative technique utilizing a buttress plate for graft fixation.

    PubMed

    Woodhouse, Andrew G; Drake, Matthew L; Lee, Gwo Chin; Levin, L Scott; Tintle, Scott M

    2015-01-01

    Core decompression with free vascularized fibular grafting is an effective hip preservation treatment for osteonecrosis of the femoral head. This procedure has traditionally utilized a single Kirschner wire to secure the fibular strut within the femoral neck. While this method has proven effective, migration of the Kirschner wire remains the most common recipient site complication. Additionally the presence of the Kirschner wire traversing the intramedullary canal can also complicate future hip arthroplasty. Therefore, this article describes a simple graft fixation technique utilizing a buttress plate that obviates migration problems. Ten patients are presented with at least 6 months of follow-up who have been treated with this technique without complications. This fixation method is simple and eliminates a major potential complication and allows for easier conversion to total hip arthroplasty. PMID:25988699

  2. Occult fracture of the femoral neck associated with extensive osteonecrosis of the femoral head: A case report

    PubMed Central

    Fukui, Kiyokazu; Kaneuji, Ayumi; Matsumoto, Tadami

    2015-01-01

    Introduction Although the subchondral portion of the femoral head is a common site for collapse in osteonecrosis of the femoral head (ONFH), femoral-neck fracture rarely occurs during the course of ONFH. We report a case of occult insufficiency fracture of the femoral neck without conditions predisposing to insufficiency fractures, occurring in association with ONFH. Presentation of case We report a case of occult fracture of the femoral neck due to extensive ONFH in a 60-year-old man. No abnormal findings suggestive of ONFH were identified on radiographs, and the fracture occurred spontaneously without any trauma or unusual increase in activity. The patient’s medical history, age, and good bone quality suggested ONFH as a possible underlying cause. Contrast-enhanced magnetic resonance imaging was useful in determining whether the fracture was caused by ONFH or was instead a simple insufficiency fracture caused by steroid use. Discussion The patient was treated with bipolar hemiarthroplasty, but if we had not suspected ONFH as a predisposing condition, the undisplaced fracture might have been treated by osteosynthesis, and this would have led to nonunion or collapse of the femoral head. To avoid providing improper treatment, clinicians should consider ONFH as a predisposing factor in pathologic fractures of the femoral neck. Conclusion ONFH should be included in the differential diagnosis of insufficiency fracture of the femoral neck. PMID:26275737

  3. Clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation: a meta-analysis of seven case-control studies.

    PubMed

    Yuan, Heng-Feng; Zhang, Jing; Guo, Chang-An; Yan, Zuo-Qin

    2016-02-01

    The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 - 0.32; p <0.001), a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p <0.01) and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 - 8.28; p<0.01). The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings. PMID:26934241

  4. Clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation: a meta-analysis of seven case-control studies

    PubMed Central

    Yuan, Heng-feng; Zhang, Jing; Guo, Chang-an; Yan, Zuo-qin

    2016-01-01

    The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 – 0.32; p<0.001), a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p<0.01) and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 – 8.28; p<0.01). The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings. PMID:26934241

  5. Vascular endothelial growth factor -634G/C polymorphism associated with osteonecrosis of the femoral head in a Chinese population.

    PubMed

    Liu, Bin; Cao, Yang; Wang, Dawei; Yao, Guijun; Bi, Zhenggang

    2012-07-01

    An impeded blood flow through the femoral head is incriminated in the etiopathogenesis of osteonecrosis of the femoral head (ONFH). Vascular endothelial growth factor (VEGF) is a strong angiogenic protein and also plays a role in the formation of cartilage and bone. The aim of this study was to evaluate the association of VEGF -634G/C polymorphism with ONFH in a Chinese population. A total of 220 unrelated patients with nontraumatic ONFH and 220 unrelated control subjects were consecutively enrolled in a hospital-based case-control study. A polymerase chain reaction-restriction fragment length polymorphism analysis was used to detect the VEGF -634G/C genotype. Patients with ONFH had a significantly higher frequency of the CC genotype (odds ratio=1.64, 95% confidence interval=1.03, 2.60; p=0.04) than controls. There were no significant associations between any genotypes and the cause of ONFH. Our results support the hypothesis that the VEGF -634CC genotype is a risk factor of ONFH in the Chinese population. However, current results should be validated prospectively in larger cohorts. PMID:22612467

  6. The prevalence and natural history of early osteonecrosis (ON) of the femoral head.

    PubMed Central

    Mulliken, B. D.; Renfrew, D. L.; Brand, R. A.; Whitten, C. G.

    1994-01-01

    We performed limited MRI exams of the hips of renal transplant patients to determine the prevalence of osteonecrosis (ON) and the natural history of early lesions. Of 132 subjects, ten patients and 15 hips were considered positive for ON (prevalence = 7.6%, bilaterality = 50%). Eleven of the MRI-positive hips were Ficat Stage 0 (asymptomatic, pre-radiographic) and were followed with serial radiographs and MRI exams. With an average follow-up of 22 months, only one of these early lesions progressed beyond Ficat 0. The other ten hips neither developed progressive MRI changes nor progressed to radiographic stages. Although our follow-up of 22 months is short, the results suggest that early ON may have a benign course in many cases. This supports the recent work of Kopecky et al., who found that many early lesions in renal transplant patients seemingly stabilize or disappear. While the prevalence was lower than in some previous reports, a significant number of patients did demonstrate previously unsuspected disease. Given the recent reports of poor results and high complication rates using "prophylactic" surgery such as core decompression for early ON, we recommend further study into the natural history of these lesions to assess the need for such procedures. In addition, we describe the use of a simple, quick and cost-effective method to screen high risk patients for early ON. PMID:7719765

  7. Comprehensive Genome-Wide Transcriptomic Analysis of Immature Articular Cartilage following Ischemic Osteonecrosis of the Femoral Head in Piglets

    PubMed Central

    Adapala, Naga Suresh; Kim, Harry K. W.

    2016-01-01

    Objective Ischemic osteonecrosis of the femoral head (ONFH) in piglets results in an ischemic injury to the immature articular cartilage. The molecular changes in the articular cartilage in response to ONFH have not been investigated using a transcriptomic approach. The purpose of this study was to perform a genome-wide transcriptomic analysis to identify genes that are upregulated in the immature articular cartilage following ONFH. Methods ONFH was induced in the right femoral head of 6-week old piglets. The unoperated femoral head was used as the normal control. At 24 hours (acute ischemic-hypoxic injury), 2 weeks (avascular necrosis in the femoral head) and 4 weeks (early repair) after surgery (n = 4 piglets/time point), RNA was isolated from the articular cartilage of the femoral head. A microarray analysis was performed using Affymetrix Porcine GeneChip Array. An enrichment analysis and functional clustering of the genes upregulated due to ONFH were performed using DAVID and STRING software, respectively. The increased expression of selected genes was confirmed by a real-time qRTPCR analysis. Results Induction of ONFH resulted in the upregulation of 383 genes at 24 hours, 122 genes at 2 weeks and 124 genes at 4 weeks compared to the normal controls. At 24 hours, the genes involved in oxidoreductive, cell-survival, and angiogenic responses were significantly enriched among the upregulated genes. These genes were involved in HIF-1, PI3K-Akt, and MAPK signaling pathways. At 2 weeks, secretory and signaling proteins involved in angiogenic and inflammatory responses, PI3K-Akt and matrix-remodeling pathways were significantly enriched. At 4 weeks, genes that represent inflammatory cytokines and chemokine signaling pathways were significantly enriched. Several index genes (genes that are upregulated at more than one time point following ONFH and are known to be important in various biological processes) including HIF-1A, VEGFA, IL-6, IL6R, IL-8, CCL2, FGF2, TGFB2

  8. High triglyceride is a risk factor for silent osteonecrosis of the femoral head in systemic lupus erythematosus.

    PubMed

    Kuroda, Takeshi; Tanabe, Naohito; Wakamatsu, Ayako; Takai, Chinatsu; Sato, Hiroe; Nakatsue, Takeshi; Wada, Yoko; Nakano, Masaaki; Narita, Ichiei

    2015-12-01

    The purpose of this study was to clarify the factors related to silent osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE). Seventy-eight patients with SLE were selected on the basis of having been newly diagnosed and requiring high-dose prednisolone, including pulse therapy with methylprednisolone, as the initial treatment. All the patients initially underwent MRI at 3 months after the start of corticosteroid treatment to detect any early changes in the femoral head. These examinations were then performed again 3 months later. Laboratory parameters were evaluated at the start of steroid treatment and at 1 month thereafter. By 3 months after the start of corticosteroid treatment, silent ONFH was diagnosed by MRI in 21 patients (26.9 %), being bilateral in 11 patients and unilateral in 10. The occurrence of silent ONFH was not related to SLE disease activity index, serological activity, or renal function; it was also unrelated to body mass index (BMI), body surface area (BSA), and the initial dose of prednisolone per unit body weight. However, the total cholesterol level at 4 weeks after the start of steroid treatment tended to be higher in patients with silent ONFH. Patients with a higher triglyceride level showed a significantly higher frequency of silent ONFH both before (p = 0.002) and 4 weeks after (p = 0.036) steroid initiation.A high triglyceride level is an important risk factor for silent ONFH in patients with SLE, and large-scale epidemiologic surveys of such early events are needed in this patient population. PMID:26384821

  9. Genetic association of the ApoB and ApoA1 gene polymorphisms with the risk for alcohol-induced osteonecrosis of femoral head

    PubMed Central

    Wang, Yuan; Cao, Yuju; Li, Yizhou; Guo, Yongchang; Wang, Quanjian; Yang, Min; Zhang, Ning; Jin, Tianbo; Wang, Jianzhong

    2015-01-01

    Polymorphisms of apolipoprotein B (ApoB), apolipoprotein A1 (ApoA1) gene and ApoB/ApoA1 Ratio were associated with lipid metabolism disorders in previous reports. The aim of this study assess whether variation of ApoB, ApoA1 gene are associated or not with alcohol-induced osteonecrosis of femoral head (ONFH). In a case-control study, we genotyped 4 single-nucleotide polymorphisms (SNPs) in ApoB and ApoA1 genes in 209 alcohol-induced ONFH patients and 300 healthy control subjects in Han Chinese population using χ2 test and genetic model analysis. The analysis revealed that the frequencies of ApoB and ApoA1 genotypes were significantly different in alcohol-induced ONFH patients than in controls. We identified rs1042034, rs676210 and rs673548 in ApoB gene were associated with decreased risk of alcohol-induced ONFH using recessive model analysis (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.19-0.99; P = 0.042), the OR, CI, P value of three SNPs were the same after adjusted for gender + age. We also identified rs632153 in ApoA1 gene was associated with increased risk of alcohol-induced ONFH using allele model (OR, 1.83; 95% CI, 1.16-2.88; P = 0.008) and log-additive model (adjusted OR, 1.77; 95% CI, 1.00-3.14; P = 0.046), analysis respectively. Haplotype analysis demonstrated no difference between ApoB and alcohol-induced ONFH. Polymorphisms of the ApoB and ApoA1 gene are associated with alcohol-induced ONFH in the Han Chinese population. PMID:26617857

  10. Radial Extracorporeal Shock Wave Therapy in a Person With Advanced Osteonecrosis of the Femoral Head

    PubMed Central

    Ma, Yue Wen; Jiang, Dong Lei; Zhang, Dai; Wang, Xiao Bei; Yu, Xiao Tong

    2016-01-01

    ABSTRACT This case report describes the first patient with avascular necrosis of the femoral head of Association Research Circulation Osseous stage IV, treated with radial extracorporeal shock wave therapy. By contrast, previous studies demonstrated the efficacy of a single treatment of focused extracorporeal shock wave therapy in improving pain and Harris Hip Scale in patients with avascular necrosis of the femoral head of Association Research Circulation Osseous stage I to III. The affected hip was treated with 6000 impulses of radial extracorporeal shock wave therapy at 10 Hz and an intensity ranging from 2.5 to 4.0 bar at 7-day intervals for 24 mos. The Harris Hip Scale values were 33, 43, 56, 77, 81, 88, and 92 at baseline and 1, 3, 6, 12, 18, and 24 mos, respectively. The radiographs showed that the subluxation of the right hip was slightly aggravated. Joint effusion was reduced, bone marrow edema disappeared, the density became more uniform, and the gluteal muscles were more developed based on magnetic resonance imaging. Increased tracer uptake was evident along the joint margin and superolateral aspect of the head both before and after radial extracorporeal shock wave therapy. This case report demonstrates the feasibility of long-term radial extracorporeal shock wave therapy in Association Research Circulation Osseous stage IV patients. PMID:27003206

  11. Radial Extracorporeal Shock Wave Therapy in a Person With Advanced Osteonecrosis of the Femoral Head.

    PubMed

    Ma, Yue Wen; Jiang, Dong Lei; Zhang, Dai; Wang, Xiao Bei; Yu, Xiao Tong

    2016-09-01

    This case report describes the first patient with avascular necrosis of the femoral head of Association Research Circulation Osseous stage IV, treated with radial extracorporeal shock wave therapy. By contrast, previous studies demonstrated the efficacy of a single treatment of focused extracorporeal shock wave therapy in improving pain and Harris Hip Scale in patients with avascular necrosis of the femoral head of Association Research Circulation Osseous stage I to III. The affected hip was treated with 6000 impulses of radial extracorporeal shock wave therapy at 10 Hz and an intensity ranging from 2.5 to 4.0 bar at 7-day intervals for 24 mos. The Harris Hip Scale values were 33, 43, 56, 77, 81, 88, and 92 at baseline and 1, 3, 6, 12, 18, and 24 mos, respectively. The radiographs showed that the subluxation of the right hip was slightly aggravated. Joint effusion was reduced, bone marrow edema disappeared, the density became more uniform, and the gluteal muscles were more developed based on magnetic resonance imaging. Increased tracer uptake was evident along the joint margin and superolateral aspect of the head both before and after radial extracorporeal shock wave therapy. This case report demonstrates the feasibility of long-term radial extracorporeal shock wave therapy in Association Research Circulation Osseous stage IV patients. PMID:27003206

  12. OPG and RANKL polymorphisms are associated with alcohol-induced osteonecrosis of the femoral head in the north area of China population in men

    PubMed Central

    Li, Yizhou; Wang, Yuan; Guo, Yongchang; Wang, Quanjian; Ouyang, Yongri; Cao, Yuju; Jin, Tianbo; Wang, Jianzhong

    2016-01-01

    Abstract Alcohol-induced osteonecrosis of the femoral head (ONFH) is an important pathogenesis of nontraumatic ONFH. However, the mechanisms of the pathogenesis are still unknown. Osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa B ligand (RANKL) have been implicated in multiple functions including blocking osteoclast maturation, controlling vascular calcifications, and promoting tumor growth and metastasis. The purpose of this article was to explore the association between OPG and RANKL gene variants and alcohol-induced ONFH. Six hundred seventy male subjects (335 patients and 335 normal individuals) were enrolled in our study. We selected 24 single-nucleotide polymorphisms (SNPs) to evaluate the association between genetic susceptibility variants and alcohol-induced ONFH using the chi-square test and gene model analysis. Overall, the OPG SNPs (rs1032128 and rs11573828) were associated with the strongest increased risk of alcohol-induced ONFH in the recessive model (rs1032128: odds ratio [OR] 1.49, 95% confidence interval [CI] 1.00–2.22, P = 0.04 for G/A; rs11573828: OR 3.32, 95% CI 1.07–10.30, P = 0.03 for T/C). The RANKL SNP rs2200287 was also an increased risk factor (OR 3.65, 95% CI 1.53–8.47, P = 0.003 for T/C) in the recessive model. The rs11573856, rs3134056, and rs1564861 SNPs were considered protective factors for alcohol-induced ONFH. We concluded that OPG and RANKL polymorphisms were associated with the occurrence of alcohol-induced ONFH. PMID:27336899

  13. Relationships among magnetic resonance imaging, histological findings, and IGF-I in steroid-induced osteonecrosis of the femoral head in rabbits* §

    PubMed Central

    Chen, Xing-can; Weng, Jian; Chen, Xue-qun; Du, Ji-zeng; Zhu, Miao-ping; Pan, Yong-qing; Liu, Miao

    2008-01-01

    Objective: To study the relationships among magnetic resonance imaging (MRI), histological findings, and insulin-like growth factor-I (IGF-I) in steroid-induced osteonecrosis of the femoral head in rabbits. Methods: Thirty rabbits were randomly divided into experimental Group A (n=15) and control Group B (n=15). The 7.5 mg/kg (2 ml) of dexamethasone (DEX) and physiological saline (2 ml) were injected into the right gluteus medius muscle twice at one-week intervals in animals of Groups A and B, respectively. At 4, 8 and 16 weeks after obtaining an MRI, the rabbits were sacrificed and the femoral head from one side was removed for histological study of lacunae empty of osteocytes, subchondral vessels, and size of fat cells under microscopy, and the femoral head from the other side was removed for enzyme-linked immunoadsorbent assay (ELISA) for IGF-I. Results: At 4, 8 and 16 weeks after treatment, no necrotic lesions were detected in Group B, while they were detected in Group A. Light microscopy revealed that the fat cells of the marrow cavity were enlarged, subchondral vessels were evidently decreased, and empty bone lacunae were clearly increased. The IGF-I levels in Group A were significantly higher than those in Group B. At 8 weeks after the DEX injection, the MRI of all 20 femora showed an inhomogeneous, low signal intensity area in the femoral head, and at 16 weeks, the findings of all 10 femora showed a specific “line-like sign”. The MRI findings of all femora in Group B were normal. Conclusion: MRI is a highly sensitive means of diagnosing early experimental osteonecrosis of the femoral head. However, the abnormal marrow tissues appeared later than 4 weeks when the expression of IGF-I increased. This reparative factor has an early and important role in response to steroid-induced osteonecrosis of the femoral head, and provides a theoretical foundation for understanding the pathology and designing new therapies. PMID:18837481

  14. Effect of Resveratrol on Preventing Steroid-induced Osteonecrosis in a Rabbit Model

    PubMed Central

    Zhai, Ji-Liang; Weng, Xi-Sheng; Wu, Zhi-Hong; Guo, Shi-Gong

    2016-01-01

    Background: Prevention of osteonecrosis (ON) has seldom been addressed. The purpose of this study was to evaluate the effect of resveratrol on preventing steroid-induced ON in rabbits. Methods: Seventy-two rabbits were divided into four groups: (1) NEC (ON) group: thirty rabbits were treated with lipopolysaccharide (LPS) once, then with methylprednisolone (MPS) daily for 3 days; (2) PRE (prevention) group: thirty rabbits were given one dose of LPS, then MPS daily for 3 days, and resveratrol on day 0 and daily for 2 weeks; (3) RES (resveratrol) group: six rabbits were given resveratrol for 2 weeks but without LPS/MPS; (4) CON (control) group: six rabbits were given alcohol for 2 weeks but without LPS/MPS. Levels of plasma tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), thrombomodulin (TM), vascular endothelial growth factor (VEGF), maximum enhancement (ME) by magnetic resonance imaging, and ON incidence were evaluated. Results: The PRE group had a lower ON incidence than the NEC group, but with no significant differences at 2 weeks and 12 weeks. The RES and CON groups did not develop ON. TM and VEGF were significantly higher in the NEC group compared with the PRE group at weeks 1, 2, and 4 (TM: 1 week, P = 0.029; 2 weeks, P = 0.005; and 4 weeks, P = 0.047; VEGF: 1 week, P = 0.039; 2 weeks, P = 0.021; 4 weeks, P = 0.014), but the difference disappeared at 12 weeks. The levels of t-PA and PAI-1 were not significantly different between the NEC and PRE groups. The TM, t-PA, PAI-1, and VEGF concentrations in the RES and CON groups did not change over time. Compared to the baseline, ME in the NEC group decreased significantly (P = 0.025) at week 1, increased significantly (P = 0.021) at week 2, and was decreased at week 12. The variance was insignificant in the PRE group. Conclusions: Resveratrol may improve blood supply to bone in a rabbit model of ON of the femoral head via anti-inflammatory effects to protect the vascular

  15. Results of Total Hip Arthroplasty after Core Decompression with Tantalum Rod for Osteonecrosis of the Femoral Head

    PubMed Central

    Lee, Gun-Woo; Kim, Do-Youn; Lee, Young-Min; Eshnazarov, Kamolhuja Eshnazarovich; Yoon, Taek-Rim

    2016-01-01

    Background Early stage osteonecrosis of the femoral head (ONFH) has many treatment options including core decompression with implantation of a tantalum rod. The purpose of this study was to evaluate clinical and radiological outcomes and potential complications during conversion total hip arthroplasty (THA) in such patients. Methods Six male patients (8 hips) underwent THA subsequent to removing a tantalum rod (group I) from April 2010 to November 2011. We retrospectively reviewed the medical records of these patients. We enrolled 12 age- and sex-matched patients (16 hips) during the same period, who had undergone primary THA without a previous operation as the control group (group II). All patients were followed for at least 3 years. We checked the Harris hip score (HHS), operative time, and volume of blood loss. Radiological results, including inclination, anteversion of the acetabular cup, presence of periprosthetic osteolysis, and subsidence of femoral stem were checked at the last follow-up. Results The mean preoperative HHS values were 56.5 (range, 50 to 62) and 59.1 (range, 42 to 70) in groups I and II, respectively. The HHS improved to 96.0 (range, 93 to 100) and 97.6 (range, 93 to 100), respectively, at the 3-year follow-up (p = 0.172). Mean operation time was 98.8 minutes (range, 70 to 120 minutes) in group I and 77.5 minutes (range, 60 to 115 minutes) in group II (p = 0.006). Total blood loss volumes were 1,193.8 mL (range, 960 to 1,360 mL) and 944.1 mL (range, 640 to 1,280 mL) in groups I and II, respectively (p = 0.004). No significant differences in inclination or anteversion of acetabular cup and no evidence of osteolysis or subsidence of the femoral stem were reported in either group in radiological follow-up results. However, one case of squeaking occurred in group I during the follow-up. Conclusions The two groups showed no clinical or radiological differences except extended operative time and increased blood loss. However, the incidence of

  16. Femoral perfusion after pulsed electromagnetic field stimulation in a steroid-induced osteonecrosis model.

    PubMed

    Ikegami, Akira; Ueshima, Keiichiro; Saito, Masazumi; Ikoma, Kazuya; Fujioka, Mikihiro; Hayashi, Shigeki; Ishida, Masashi; Fujiwara, Hiroyoshi; Mazda, Osam; Kubo, Toshikazu

    2015-07-01

    This study was designed to evaluate femoral perfusion after pulsed electromagnetic field (PEMF) stimulation in a steroid-induced osteonecrosis rabbit model by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Steroid-induced osteonecrosis was produced by single intramuscular injection of methylprednisolone in 15 rabbits. Eight rabbits underwent PEMF stimulation (PEMF group) and seven did not (control group). DCE-MRI was performed before PEMF stimulation, immediately before steroid administration, and 1, 5, 10, and 14 days after steroid administration. Regions of interest were set in the bilateral proximal femora. Enhancement ratio (ER), initial slope (IS), and area under the curve (AUC) were analyzed. ER, IS, and AUC in the control group significantly decreased after steroid administration compared with before administration (P<0.05). In PEMF group, IS significantly decreased; however, ER and AUC showed no significant differences after steroid administration compared with before. ER and IS in PEMF group were higher than in control group until 10th day, and AUC was higher until 5th day after steroid administration (P<0.05). PEMF stimulation restrains the decrease in blood flow after steroid administration. PMID:25808585

  17. The Fate and Distribution of Autologous Bone Marrow Mesenchymal Stem Cells with Intra-Arterial Infusion in Osteonecrosis of the Femoral Head in Dogs

    PubMed Central

    Jin, Hongting; Xu, Taotao; Chen, Qiqing; Wu, Chengliang; Wang, Pinger; Mao, Qiang; Zhang, Shanxing; Shen, Jiayi; Tong, Peijian

    2016-01-01

    This study aimed to investigate if autologous bone marrow mesenchymal stem cells (MSCs) could treat osteonecrosis of the femoral head (ONFH) and what the fate and distribution of the cells are in dogs. Twelve Beagle dogs were randomly divided into two groups: MSCs group and SHAM operated group. After three weeks, dogs in MSCs group and SHAM operated group were intra-arterially injected with autologous MSCs and 0.9% normal saline, respectively. Eight weeks after treatment, the necrotic volume of the femoral heads was significantly reduced in MSCs group. Moreover, the trabecular bone volume was increased and the empty lacunae rate was decreased in MSCs group. In addition, the BrdU-positive MSCs were unevenly distributed in femoral heads and various vital organs. But no obvious abnormalities were observed. Furthermore, most of BrdU-positive MSCs in necrotic region expressed osteocalcin in MSCs group and a few expressed peroxisome proliferator-activated receptor-γ (PPAR-γ). Taken together, these data indicated that intra-arterially infused MSCs could migrate into the necrotic field of femoral heads and differentiate into osteoblasts, thus improving the necrosis of femoral heads. It suggests that intra-arterial infusion of autologous MSCs might be a feasible and relatively safe method for the treatment of femoral head necrosis. PMID:26779265

  18. Combining Concentrated Autologous Bone Marrow Stem Cells Injection With Core Decompression Improves Outcome for Patients with Early-Stage Osteonecrosis of the Femoral Head: A Comparative Study.

    PubMed

    Tabatabaee, Reza Mostafavi; Saberi, Sadegh; Parvizi, Javad; Mortazavi, Seyed Mohammad Javad; Farzan, Mahmoud

    2015-09-01

    The management of early-stage osteonecrosis of the femoral head (ONFH) remains challenging. This study aimed to evaluate the effects of core decompression and concentrated bone marrow implantation on ONFH. The study recruited 28 hips with early ONFH randomly assigned into two groups of core decompression with (group A) and without (group B) bone marrow injection. Patients were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Visual Analogue Scale (VAS) pain index, and MRI. The mean WOMAC and VAS scores in all patients improved significantly (P<0.001). MRI showed a significant improvement in group A (P=0.046) and significant worsening in group B (P<0.001). Bone marrow stem cell injection with core decompression can be effective in early ONFH. PMID:26143238

  19. Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey

    PubMed Central

    Zhao, De-Wei; Yu, Mang; Hu, Kai; Wang, Wei; Yang, Lei; Wang, Ben-Jie; Gao, Xiao-Hong; Guo, Yong-Ming; Xu, Yong-Qing; Wei, Yu-Shan; Tian, Si-Miao; Yang, Fan; Wang, Nan; Huang, Shi-Bo; Xie, Hui; Wei, Xiao-Wei; Jiang, Hai-Shen; Zang, Yu-Qiang; Ai, Jun; Chen, Yuan-Liang; Lei, Guang-Hua; Li, Yu-Jin; Tian, Geng; Li, Zong-Sheng; Cao, Yong; Ma, Li

    2015-01-01

    Background: Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population. Methods: A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH. Results: NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ2 = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ2 = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH. Conclusions: Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares

  20. Pulsed electromagnetic fields protect the balance between adipogenesis and osteogenesis on steroid-induced osteonecrosis of femoral head at the pre-collapse stage in rats.

    PubMed

    Li, Jian-Ping; Chen, Sen; Peng, Hao; Zhou, Jian-Lin; Fang, Hong-Song

    2014-04-01

    This study was designed to investigate the effects of pulsed electromagnetic fields (PEMF) on the balance of adipogenesis and osteogenesis on steroid-induced osteonecrosis of the femoral head (OFH) in rats. Forty-two rats were divided into three groups: Steroid group (S, n = 16); Steroid + PEMF group (S + P, n = 16); and Control group (C, n = 10). For groups S and S + P, all rats were first intravenously given 10 µg/kg lipopolysaccharide on day 1, and then intramuscularly injected with 20 mg/kg methylprednisolone acetate on days 2, 3, and 4, with an interval of 24 h. After 4 weeks, the S + P group was treated with PEMF (4.5-ms square pulse, repeated at 15 Hz, with a peak of 1.2 mT) for 4 h a day for the next 8 weeks. Group S was not exposed to PEMF. Group C was chosen as the control group, without steroid use and exposure to PEMF. After 8 weeks of treatment, the histological changes, and mRNA and protein expressions of PPAR-γ2 and Runx2 were measured and analyzed. Compared with the S group, lower incidence of osteonecrosis (31% vs. 69%, P < 0.05) and empty osteocyte lacuna rate (36.16 ± 15.34 vs. 59.55 ± 21.70, P < 0.01) was observed in the S + P group. Furthermore, PEMF suppressed the expressions of PPAR-γ2 and improved the expressions of Runx2 in the femoral head (P < 0.05). All data suggest that PEMF is an effective physiotherapy in the treatment of steroid-induced ONFH, and the possible underlying mechanisms include protecting the balance between adipogenesis and osteogenesis. PMID:24421074

  1. An Exploratory Clinical Trial for Idiopathic Osteonecrosis of Femoral Head by Cultured Autologous Multipotent Mesenchymal Stromal Cells Augmented with Vascularized Bone Grafts

    PubMed Central

    Aoyama, Tomoki; Goto, Koji; Kakinoki, Ryosuke; Ikeguchi, Ryosuke; Ueda, Michiko; Kasai, Yasunari; Maekawa, Taira; Tada, Harue; Teramukai, Satoshi; Nakamura, Takashi

    2014-01-01

    Idiopathic osteonecrosis of femoral head (ION) is a painful disorder that progresses to collapse of the femoral head and destruction of the hip joint. Although its precise pathology remains unknown, the loss of blood supply causing the loss of living bone-forming cells is a hallmark of the pathophysiology of osteonecrosis. Transplantation of multipotent mesenchymal stromal cells (MSCs) is a promising tool for regenerating the musculoskeletal system. The aim of the present study was to assess the safety and efficacy of transplantation of cultured autologous bone marrow-derived MSCs mixed with β-tricalcium phosphate (β-TCP) in combination with vascularized bone grafts for the treatment of advanced stage ION in a clinical trial. Ten patients with stage 3 ION were enrolled in this study. Autologous bone marrow-derived MSCs were cultured with autologous serum, and cells (0.5–1.0×108) were transplanted after mixing with β-TCP granules in combination with vascularized iliac bone grafts. Patients were assessed 24 months after treatment. The primary and secondary endpoints were progression of the radiological stage and changes in bone volume at the femoral head, and clinical score, respectively. Nine of ten patients completed the protocol, seven of whom remained at stage 3, and the remaining two cases progressed to stage 4. The average bone volume increased from 56.5±8.5 cm3 to 57.7±10.6 cm3. The average clinical score according to the Japan Orthopaedic Association improved from 65.6±25.5 points to 87.9±19.0 points. One severe adverse event was observed, which was not related to the clinical trial. Although the efficacy of cell transplantation was still to be determined, all procedures were successfully performed and some young patients with extensive necrotic lesions with pain demonstrated good bone regeneration with amelioration of symptoms. Further improvements in our method using MSCs and the proper selection of patients will open a new approach for the

  2. Animal models for bisphosphonate-related osteonecrosis of the jaws--an appraisal.

    PubMed

    Sharma, D; Hamlet, S; Petcu, E; Ivanovski, S

    2013-11-01

    The prolonged use of bisphosphonates has been shown to cause a condition termed 'bisphosphonate related osteonecrosis of the jaws' (BRONJ). BRONJ is a disease entity which has only been described relatively recently, and its multi-factorial aetiology is yet to be fully elucidated. Therefore, the treatment of BRONJ lesions remains a challenge, and animal models are necessary to assist researchers in better understanding the disease. This has led to the recent publication of a number of studies utilising a variety of animal models of BRONJ. This review outlines the factors to be considered when selecting an animal model for BRONJ and discusses the current literature in this rapidly progressing field of research. It is important to consider the applicability of a given model to the clinical condition presenting in humans, and to this end, thorough characterisation of the clinical, histological, radiographic and systemic features is necessary. The development of a clinical lesion is an important consideration in terms of choosing a relevant model, and it appears clear that surgical manipulation, generally involving tooth extraction, is necessary for successful induction of the classic 'clinical' lesion of BRONJ. PMID:23346935

  3. Outcomes of total hip arthroplasty in patients with osteonecrosis of the femoral head-a current review.

    PubMed

    Pierce, Todd P; Elmallah, Randa K; Jauregui, Julio J; Verna, Daniel F; Mont, Michael A

    2015-09-01

    The purpose of this review was to analyze (1) patient-reported outcomes and implant survivorship of osteonecrosis (ON) patients following total hip arthroplasty (THA), (2) if prior hip-preserving procedures influence these outcomes, (3) if resurfacing procedures alter outcomes; and (4) how these outcomes may have been impacted by the choice of different bearing surfaces. Today, with implant innovations such as cementless constructs, ceramic bearing surfaces, and highly cross-linked polyethylene, ON patients derive great benefit and have high survivorship following THA. Most studies have shown that previous hip-preserving procedures do not have a deleterious effect on outcomes. Literature on the use of ceramic and highly cross-linked polyethylene bearing surfaces have shown that these implant designs are useful in younger and more active patients. Future research should evaluate the long-term outcomes and survivorship of these new THA constructs. PMID:26045086

  4. Transplantation of iliac bone flaps pedicled with sartorius muscular fascia around superficial circumflex iliac vessels in the treatment of osteonecrosis of the femoral head

    PubMed Central

    CUI, GUOFENG; WEI, RONG; HOU, CHUNYING; BI, ZHENGGANG

    2016-01-01

    The aim of this study was to evaluate the efficacy and clinical application of iliac bone flaps pedicled with sartorius muscular fascia around superficial circumflex iliac vessels for the treatment of Association for Research on Osseous Circulation (ARCO) stage II–III osteonecrosis of the femoral head (ONFH) in young adults. In total, 35 patients with ONFH at ARCO stage II–III were treated with iliac bone flaps pedicled with sartorius muscular fascia around superficial circumflex iliac vessels. Patients were classified according to etiological factors and ARCO stages. Postoperative clinical assessment was accomplished with Harris hip scores (HHSs), and ARCO stage change was evaluated with imaging. All 35 patients completed the follow-up. The HHS results indicated that hip function was improved significantly from the preoperative status of 56.53±7.66 points to the postoperative status of 87.49±5.89 points (P<0.0001). Postoperative imaging displayed apparent osteogenesis and satisfactory structural remodeling in 32 patients, presenting no staging progress. Three patients exhibited mild collapse (<2 mm) compared with preoperative collapse. No patients developed osteoarthritis or required total hip arthroplasty. The clinical success rate was 91.43%. Iliac bone flaps pedicled with sartorius muscular fascia around superficial circumflex iliac vessels is a feasible means for treating ARCO stage II–III ONFH in young adults, who have abundant blood circulation, good osteogenesis and function of the hip. It is also an effective means for retaining the femoral head. PMID:27284301

  5. Population pharmacokinetic and pharmacodynamic modeling for assessing risk of bisphosphonate-related osteonecrosis of the jaw

    PubMed Central

    Sedghizadeh, Parish P.; Jones, Allan C.; LaVallee, Chris; Jelliffe, Roger W.; Le, Anh D.; Lee, Peter; Kiss, Andrew; Neely, Michael

    2012-01-01

    Objective We hypothesized that patients with bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) accumulate higher levels of BP in bone than those without BRONJ. Study Design Using the Pmetrics® package and published data, we designed a population pharmacokinetic model of pamidronate concentration in plasma and bone and derived a toxic bone BP threshold of 0.2 mM. With the model, and using patient individual BP duration and bone mineral content estimated from lean body weight, we calculated bone BP levels in 153 subjects. Results Mean bone BP in 69 BRONJ cases was higher than in 84 controls (0.20 vs. 0.10 mM, P<0.001) consistent with the toxic bone threshold of 0.2 mM. BRONJ was also associated with longer duration BP therapy (5.3 vs. 2.7 years, P<0.001), older age (76 vs. 70 years, P<0.001), and Asian race (49% vs. 14%, P<0.001). Conclusions Our model accurately discriminated BRONJ cases from controls, among patients on BP therapy. PMID:23246224

  6. A novel model of bisphosphonate-related osteonecrosis of the jaw in rats

    PubMed Central

    Yang, Huawei; Pan, Hui; Yu, Fang; Chen, Kai; Shang, Guangwei; Xu, Yuanzhi

    2015-01-01

    Objective: To establish a rat model of bisphosphonate-related osteonecrosis of the jaw (BRONJ) that realistically mimics major clinical manifestations of the disease. Methods: Female Sprague Dawley rats received intravenous zoledronate 80 μg/kg once a week via the tail vein. Three weeks after intravenous injection, maxillary first molars were extracted under general anesthesia. Then 1, 4 and 12 weeks after tooth extraction, the rats were euthanized, and the intact maxillas were harvested en bloc. Macroscopic analysis, histological analysis and cytokine analysis were performed. Untreated rats with tooth extraction were used as controls. Results: 12 weeks after extraction, rats treated with zoledronate developed BRONJ-like disease, including characteristic features of impaired soft tissue healing, exposed necrotic bone or sequestra, increased inflammatory infiltrates, while the controls showed normal bone healing. 4 weeks after extraction, rats treated with zoledronate exhibited the decreased receptor activator of nuclear factor kappa-B ligand (RANKL) values, the increased osteoprotegerin (OPG) values and the remarkable decreased RANKL/OPG ratio when compared with the controls. Conclusion: The rats treated with zoledronate can be considered a novel, reliable and reproducible animal model to better understand the pathophysiology and pathogenesis of BRONJ and to develop a therapeutic approach. PMID:26191212

  7. A Model for Osteonecrosis of the Jaw with Zoledronate Treatment following Repeated Major Trauma

    PubMed Central

    Howie, R. Nicole; Borke, James L.; Kurago, Zoya; Daoudi, Asma; Cray, James; Zakhary, Ibrahim E.; Brown, Tara L.; Raley, J. Nathan; Tran, Loan T.; Messer, Regina; Medani, Fardous; Elsalanty, Mohammed E.

    2015-01-01

    This study aims to develop a reproducible rat model for post-traumatic bisphosphonate-related osteonecrosis of the jaw (BRONJ). In our previous studies using dental extraction as an inducing factor, only 30% - 60% of zoledronate-treated animals fulfilled the definition of clinical BRONJ. We modified the zoledronate regimen and introduced repeated surgical extraction to illicit quantifiable BRONJ in all animals. Eighty retired-breeder female Sprague-Dawley rats were divided between the treatment (IV zoledronate; 80 μg/kg/week for 13 weeks) and control (saline) groups. On week 13, the left mandibular first molar was surgically extracted, followed by the second molar a week later. Animals were euthanized at 1-week, 2-weeks, and 8-weeks following extraction. The occurrence and severity of BRONJ were scored in each animal based on gross and MicroCT analysis. Parameters of bone formation and osteoclast functions at the extraction site were compared between groups. All zoledronate-treated animals developed a severe case of BRONJ that fulfilled the clinical definition of the condition in humans. Osteoclast attachment continued to be defective eight weeks after stopping the treatment. There were no signs of kidney or liver toxicity. Our data confirmed that repeated surgical extraction (major trauma) by itself consistently precipitated massive bone necrosis in ZA-treated animals, eliminating the need to induce pre-existing infection or comorbidity. These results will be the basis for further studies examining the in-vivo pathogenesis and prevention of BRONJ. PMID:26186665

  8. Early Outcomes of Primary Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients with Human Immunodeficiency Virus in China

    PubMed Central

    Zhao, Chang-Song; Li, Xin; Zhang, Qiang; Sun, Sheng; Zhao, Ru-Gang; Cai, Juan

    2015-01-01

    Background: Studies have reported that patients with human immunodeficiency virus (HIV) have a high incidence of osteonecrosis of the femoral head (ONFH). Total hip arthroplasty (THA) is an effective management of ONFH. However, little data exist regarding the use of THA for the HIV patients with ONFH in China. This study reviewed the outcomes of HIV-positive patients who underwent THA for ONFH, compared with HIV-negative individuals. Methods: The patients who underwent THA for ONFH from September 2012 to September 2014 in Beijing Ditan Hospital, Capital Medical University were retrospectively studied. Twenty-eight HIV-positive patients and 35 HIV-negative patients underwent 48 THAs and 45 THAs with cementless components, respectively. Medical records and follow-up data were reviewed. Harris Hip Score (HHS) was applied to evaluate the pain and function of the hips before and after THA. Complications such as wound healing, surgical site infection, deep venous thrombosis, pulmonary embolism, sepsis, mortality, and complications from the prosthesis were reviewed. The operation time, blood loss, and hospital stay were compared between the two groups. Results: The mean follow-up period was 19.5 ± 5.8 months (ranging from 6 to 30 months). The mean age of the HIV-positive patients with osteonecrosis at the time of surgery was 35 years old, which was significantly lower than that of the HIV-negative group (42 years old) (P < 0.05). The HIV-positive patients underwent surgery a mean of 2.5 years after their original symptoms, which was significantly shorter than the HIV-negatives’ (mean 4 years) (P < 0.05). Among HIV-positive patients, the prevalence of being male and rate of bilateral procedures were significantly higher than those in the HIV-negative group (P < 0.05). The operation time in HIV-positive patients was significantly longer than that in HIV-negative patients (P < 0.05). There were no significant differences in blood loss or hospital stay between the two

  9. Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head: results from a series of 407 cases.

    PubMed

    Gao, You-Shui; Chen, Sheng-Bao; Jin, Dong-Xu; Sheng, Jia-Gen; Cheng, Xiang-Guo; Zhang, Chang-Qing

    2013-11-01

    The goal for treatment of osteonecrosis of the femoral head (ONFH) is to relieve pain, preserve the contour of the femoral head, and delay the need for total hip arthroplasty. The free vascularized fibular grafting (FVFG) has been shown to support the subchondral architecture as well as restore local circulation for the necrotic femoral head in treatment of ONFH. This report aimed to present the clinical results of the use of a modified surgical technique of FVFG for treatment of ONFH. Four hundred and seven patients with 578 hips of ONFH were included. The patients' average age was 36.7 years old (ranging 19-55 years old). The disease was staged from II to V based on the Steinberg classification system. By the modified procedure, the vascularized fibular graft was harvested via a lateral incision with fibular osteotomy prior to the exposure of the vascular pedicle, and the removal of necrotic tissue and inset of graft were performed through an anterior approach. The operative time averaged 90 min for unilateral ONFH (ranging 75-110 min) and 190 min for simultaneous treatment of bilateral ONFH (ranging 160-230 min). The average length of follow-up was 5.0 years (ranging 3-10 years). The complications included one infection in one case, temporary loss of sensation of the thigh in eleven cases, and restricted motion of the great toe in nine cases. The Harris hip score of patients improved from 65.0 to 86.9 on average. Radiographic evaluation showed no changes in 331 hips (57.3%), improvement in 195 hips (33.7%) and necrosis progression in 52 hips (9.0%). Twenty-three hips (4.0%) in 20 patients had total hip arthroplasty during the period. These results show that the modified technique of the use of FVFG for treatment of ONFH yields similar postoperative results in comparison to the traditional method. PMID:23907776

  10. National Osteonecrosis Foundation

    MedlinePlus

    ... understands and cares. We Do! The National Osteonecrosis Foundation is made up of a group of patients, ... if you would like more information on this foundation. National Osteonecrosis Foundation P.O. Box 518 Jarrettsville, ...

  11. [Aseptic osteonecrosis of alcoholic origin: a case report].

    PubMed

    Jissendi Tchofo, P; Brasseur, P

    2001-06-01

    Alcohol-induced aseptic osteonecrosis is not infrequent but multifocal osseous destruction is very rare. Alcoholic patients often present lipidic metabolism perturbation with fat embolism and are susceptible to develop diffuse intravascular coagulation in terminal microcirculation of femoral and humeral heads. The authors report one case of multifocal alcohol-induced osteonecrosis in a 74 year-woman. She presented with bilateral osteonecrosis of the humeral heads and total osteolysis of the neck and the head of the hips. Hepatic cirrhosis and chronic pancreatitis were additional risk factors inducing intra-osseous thrombosis. PMID:11488085

  12. Prevalence of Clinical Anxiety, Clinical Depression and Associated Risk Factors in Chinese Young and Middle-Aged Patients with Osteonecrosis of the Femoral Head

    PubMed Central

    Gao, You-Shui; He, Hai-Yan; Jin, Dong-Xu; Zhang, Chang-Qing

    2015-01-01

    Objective To investigate the prevalence of clinical anxiety and clinical depression in Chinese young and mid-aged patients with osteonecrosis of the femoral head (ONFH) and to analyze their potential risk factors. Methods Two hundred and sixteen Chinese patients with ONFH were consecutively enrolled in this cross-sectional study from January 2010 to December 2010. The Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS) were used to assess the prevalence of clinical anxiety and clinical depression. An additional questionnaire containing seventeen items of potential risk factors was completed by all patients. Binary logistic regression analysis was employed to reveal potential risk factors of anxiety and depression. Results The prevalence of clinical anxiety and clinical depression was 20.4% and 21.8% in Chinese young and middle-aged patients with ONFH, respectively. Binary regression analysis showed that independent risk factors correlated with high incidence of clinical anxiety included involved femoral head (OR = 3.168, 95% CI: 1.496 - 6.708) and stages of ONFH (ORIV-V / II = 5.383, 95% CI: 1.664-17.416). Independent risk factors correlated with high incidence of depression included gender (OR = 2.853, 95% CI: 1.467-5.778), comorbid diseases (OR = 4.243, 95% CI: 1.940-9.278) and stages of the disease (OR IV-V/II = 16.963, 95% CI: 4.404-65.331). Conclusions Patients with bilateral ONFH are inclined to have clinical anxiety, while female patients and patients with comorbid diseases might tend to get clinical depression. Advanced stages of ONFH are independent risk factors for both clinical anxiety and clinical depression. PMID:25789850

  13. Comparison of Perioperative Blood Loss in Primary Non-cemented Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis and Osteonecrosis of the Femoral Head

    PubMed Central

    Song, Joo-Hyoun; Han, Suk Ku; Lee, Kyung-Hoon; Lee, Jae-Min

    2015-01-01

    Purpose The purpose of this study is to compare the perioperative blood loss in primary non-cemented total hip arthroplasty (THA) performed for rapidly destructive coxarthrosis (RDC) with the perioperative blood loss in primary non-cemented THA for typical osteonecrosis of the femoral head (ONFH). Materials and Methods From January 2000 to December 2013, 19 patients were diagnosed with RDC (group 1) and 40 patients were diagnosed typical Ficat stage IV ONFH (group 2), comparison of perioperative blood loss between group 1 and group 2 in primary noncemented THA was done. Patients with preoperative usage of steroid or anticoagulants medication and with hemodynamic abnormal blood test results were excluded. The blood loss was measured up to the fifth post operation day and calculated with formula proposed by Mercuriali, Inghilleri and Nadler. Results Non-compensated blood loss calculated in milliliters of red blood cells was 362 mL (standard deviation [SD], 187; range, 77-675) in group 1 and 180 mL (SD, 145; range, 53-519) in group 2. Compensated blood loss was 630 mL (SD, 180; range, 380-760) in group 1 and 503 mL (SD, 260; range, 190-1, 505) in group 2. The total blood loss after primary non-cemented THA is greater when surgery is performed for RDC than for ONFH, with the volume of 992 mL (SD, 300; range, 457-1, 434) in group 1 and 683 mL (SD, 360; range, 226-1, 975) in group 2 respectively. Conclusion Total perioperative blood loss was significantly greater in RDC than in ONFH in primary non-cemented THA. PMID:27536617

  14. Osteonecrosis in Sickle Cell Disease.

    PubMed

    Naseer, Zan A; Bachabi, Malick; Jones, Lynne C; Sterling, Robert S; Khanuja, Harpal S

    2016-09-01

    Osteonecrosis is one of the most devastating musculoskeletal manifestations of sickle cell disease and most commonly affects the femoral head. Although the exact pathophysiology of this condition in patients with sickle cell disease is unknown, it is suggested that red cell sickling and repetitive vaso-occlusion may be associated with tissue hypoxia, inflammation, and subsequent bone necrosis and collapse. If left untreated, osteonecrosis can be extremely debilitating and may lead to severe pain, loss of function, and degenerative joint changes. Although several conservative management approaches exist, total joint arthroplasty remains the most effective treatment intervention. A multidisciplinary approach among the primary care physician, hematologist, and orthopedic surgeon is essential in optimizing patient management. PMID:27598354

  15. A novel soft-tissue in vitro model for bisphosphonate-associated osteonecrosis

    PubMed Central

    2010-01-01

    Background Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) has been reported in patients receiving intravenous BP, particularly zoledronic acid (ZA). The purpose of this study was to develop an in vitro model representative of the effects BP has on soft tissue secondary to its release from bone. Human gingival fibroblasts and oral epithelial cell lines were exposed to various concentrations (0-10 μM) of ZA using dentine discs (DDs) as a direct carrier of BP, which were exposed for 24 hours to ZA in normal medium (NM), washed in phosphate-buffered saline (PBS) and placed in a new co-culture with the cells. The cells were allowed to proliferate until they grew over the bone discs and then the discs either were left unchelated, or were chelated using 0.001% EDTA or EGTA to release BP from the discs and to observe the cellular effects. Direct effects were determined using direct and fluorescent imaging. Apoptotic effects were determined by vital stain, terminal dUTP nick-end labeling, and annexin V studies. The effect on cell proliferation was determined by mitochondrial tetrazolium salt assay. The level of BP release was determined based on the effect of BP directly on cells, using the DDs or the supernatant fluids resulting from chelation. Results A dose-response effect was seen on imaging, and effects on apoptosis and cell proliferation were observed with increasing ZA concentrations liberated from the DDs, particularly after calcium cleavage and release of ZA from the DDs with a variety of chelating agents. Apoptotic effects were observed microscopically after chelation at 24 hours. Release of ZA was confirmed by extracting medium from non-chelated and chelated cell culture models with DDs and applying this medium to untreated fresh cell cultures, providing appropriate controls. Conclusions The results from this study demonstrate that low concentrations of ZA released from bone can rapidly and directly affect the oral mucosal tissues, initially

  16. Prediction of posttraumatic femoral head osteonecrosis by quantitative intraosseous aspirate and core biopsy analysis: a prospective study.

    PubMed

    Sen, Ramesh Kumar; Tripathy, Sujit Kumar; Gill, Shivinder Singh; Verma, Neelam; Singh, Paramjeet; Radotra, Bishan Dass

    2010-08-01

    Twenty-two patients with unreduced hip dislocation or fracture dislocation were prospectively evaluated. Intraosseous aspiration, marrow fluid analysis and core biopsy histological analysis was performed from the supero-lateral (test group) and central part (control group) of the femoral head. After appropriate surgical treatment and postoperative management, they were followed up for 2 years by clinical, radiological and magnetic resonance imaging evaluation. Eight patients eventually developed avascular necrosis (AVN) of the femoral head. The analysis of test samples revealed that 9 patients had an aspirate volume of < 1 cc ; marrow morphology of 11 hips showed necrotic cells; 12 patients had a core biopsy histology suggestive of dead osseous fragments and necrotic osteocytes. In contrast, all the control samples had an aspirate volume of > 1cc and showed viable cells on histology. Intra-operative assessment of marrow-aspirate volume (< 1cc), marrow morphology and core biopsy histology from the superolateral part of femur head can fairly predict the development of subsequent ONFH after trauma; the correlation is statistically significant (p < 0.05). PMID:20973355

  17. Core Decompression and Autologous Bone Marrow Concentrate for Treatment of Femoral Head Osteonecrosis: A Randomized Prospective Study

    PubMed Central

    Pepke, Wojciech; Kasten, Philip; Beckmann, Nicholas A.; Janicki, Patricia; Egermann, Marcus

    2016-01-01

    The aim of this study was to investigate the safety of injection of bone marrow aspirate concentrate during core decompression and to study its clinical (visual analogue scale; Harris-Hip-score) and radiological outcomes (magnetic resonance imaging). In this prospective and randomized clinical trial we evaluated 24 consecutive patients with non-traumatic femoral head necrosis (FHN) during a period of two years after intervention. In vitro analysis of mesenchymal stem cells was performed by evaluating the fibroblast colony forming units (CFU-Fs). Postoperatively, significant decrease in pain associated with a functional benefit lasting was observed. However, there was no difference in the clinical outcome between the two study groups. Over the period of two years there was no significant difference between the head survival rate between both groups. In contrast to that, we could not perceive any significant change in the volume of FHN in both treatment groups related to the longitudinal course after treating. The number of CFU showed a significant increase after centrifugation. This trial could not detect a benefit from the additional injection of bone marrow concentrate with regard to bone regeneration and clinical outcome in the short term. PMID:27114808

  18. Core Decompression and Autologous Bone Marrow Concentrate for Treatment of Femoral Head Osteonecrosis: A Randomized Prospective Study.

    PubMed

    Pepke, Wojciech; Kasten, Philip; Beckmann, Nicholas A; Janicki, Patricia; Egermann, Marcus

    2016-03-21

    The aim of this study was to investigate the safety of injection of bone marrow aspirate concentrate during core decompression and to study its clinical (visual analogue scale; Harris-Hip-score) and radiological outcomes (magnetic resonance imaging). In this prospective and randomized clinical trial we evaluated 24 consecutive patients with non-traumatic femoral head necrosis (FHN) during a period of two years after intervention. In vitro analysis of mesenchymal stem cells was performed by evaluating the fibroblast colony forming units (CFU-Fs). Postoperatively, significant decrease in pain associated with a functional benefit lasting was observed. However, there was no difference in the clinical outcome between the two study groups. Over the period of two years there was no significant difference between the head survival rate between both groups. In contrast to that, we could not perceive any significant change in the volume of FHN in both treatment groups related to the longitudinal course after treating. The number of CFU showed a significant increase after centrifugation. This trial could not detect a benefit from the additional injection of bone marrow concentrate with regard to bone regeneration and clinical outcome in the short term. PMID:27114808

  19. Spontaneous Osteonecrosis of the Jaws in the Maxilla of Mice on Antiresorptive Treatment: A Novel ONJ Mouse Model

    PubMed Central

    de Molon, Rafael Scaf; Cheong, Simon; Bezouglaia, Olga; Dry, Sarah M; Pirih, Flavia; Cirelli, Joni Augusto; Aghaloo, Tara L; Tetradis, Sotirios

    2015-01-01

    Although osteonecrosis of the jaws (ONJ), a serious complication of antiresorptive medications, was reported a decade ago, the exact mechanisms of disease pathophysiology remain elusive. ONJ-like lesions can be induced in animals after antiresorptive treatment and experimental interventions such as tooth extraction or periapical or periodontal disease. However, experimental induction and manipulation of disease progression does not always reflect clinical reality. Interestingly, naturally occurring maxillofacial abscesses, inducing aggressive inflammation of the peri-radicular mucosa with significant osteolysis and alveolar bone expansion, have been reported in mice. Here, we aimed to explore whether osteonecrotic lesions would develop in areas of maxillary peri-radicular infections, in mice on antiresorptive medications with distinct pharmacologic action, thus establishing a novel ONJ animal model. Mice were treated with RANK-Fc or OPG-Fc that bind to RANKL or with the potent bisphosphonate zoledronic acid (ZA). Maxillae were assessed radiographically and histologically. μCT imaging of vehicle mice revealed several maxillae with altered alveolar bone morphology, significant ridge expansion and large lytic areas. However, in RANK-Fc, OPG-Fc and ZA treated animals the extent of bone loss was significantly less, but exuberant bone deposition was noted at the ridge periphery. BV and BV/TV were increased in the diseased site of antiresorptive vs. veh animals. Histologically, extensive inflammation, bone resorption and marginal gingival epithelium migration were seen in the diseased site of vehicle animals. Rank-Fc, OPG-Fc and ZA reduced alveolar bone loss, increased periosteal bone formation, and induced areas of osteonecrosis, and bone exposure that in many animals covered significant part of the alveolar bone. Collectively, our data demonstrate ONJ-like lesions at sites of maxillary peri-radicular infection, indistinguishable in mice treated with RAKL inhibitors vs

  20. Spontaneous osteonecrosis of the jaws in the maxilla of mice on antiresorptive treatment: a novel ONJ mouse model.

    PubMed

    de Molon, Rafael Scaf; Cheong, Simon; Bezouglaia, Olga; Dry, Sarah M; Pirih, Flavia; Cirelli, Joni Augusto; Aghaloo, Tara L; Tetradis, Sotirios

    2014-11-01

    Although osteonecrosis of the jaws (ONJ), a serious complication of antiresorptive medications, was reported a decade ago, the exact mechanisms of disease pathophysiology remain elusive. ONJ-like lesions can be induced in animals after antiresorptive treatment and experimental interventions such as tooth extraction or periapical or periodontal disease. However, experimental induction and manipulation of disease progression does not always reflect clinical reality. Interestingly, naturally occurring maxillofacial abscesses, inducing aggressive inflammation of the peri-radicular mucosa with significant osteolysis and alveolar bone expansion, have been reported in mice. Here, we aimed to explore whether osteonecrotic lesions would develop in areas of maxillary peri-radicular infections, in mice on antiresorptive medications with distinct pharmacologic action, thus establishing a novel ONJ animal model. Mice were treated with RANK-Fc or OPG-Fc that bind to RANKL or with the potent bisphosphonate zoledronic acid (ZA). Maxillae were assessed radiographically and histologically. μCT imaging of vehicle mice revealed several maxillae with altered alveolar bone morphology, significant ridge expansion and large lytic areas. However, in RANK-Fc, OPG-Fc and ZA treated animals the extent of bone loss was significantly less, but exuberant bone deposition was noted at the ridge periphery. BV and BV/TV were increased in the diseased site of antiresorptive vs. veh animals. Histologically, extensive inflammation, bone resorption and marginal gingival epithelium migration were seen in the diseased site of vehicle animals. Rank-Fc, OPG-Fc and ZA reduced alveolar bone loss, increased periosteal bone formation, and induced areas of osteonecrosis, and bone exposure that in many animals covered significant part of the alveolar bone. Collectively, our data demonstrate ONJ-like lesions at sites of maxillary peri-radicular infection, indistinguishable in mice treated with RAKL inhibitors vs

  1. Relation between the development of osteoporosis and osteonecrosis following glucocorticoid in a rabbit model

    PubMed Central

    Lin, Tao; Liu, Junbin; Yang, Shuhua; Liu, Xianzhe; Feng, Xiaobo; Fu, Dehao

    2016-01-01

    Background: There has been a recent increase in the number of patients suffering from bone and joint diseases, as a consequence of corticosteroids administration. There are more patients treated with low dose of GCs under long-term conditions in clinical, such as effect of GCs on Rheumatoid arthritis, Crohn's disease and Asthma patients. Hence, it was difficult for doctor to determine which problem occur first – OP or ON; however, there was no clinical report previously in the literature, and there was no effective animal model of OP and ON about low dose GCs. This study was conducted to develop rabbit models of glucocorticoid (GC)-induced femoral head ON and OP and to investigate the temporal relationship between the occurrence of the two events following administration of glucocorticoids. Materials and Methods: Fifty six, 6 months old female rabbits were randomly divided into the GC group and control group (C). Rabbits received gluteal injections of methylprednisolone sodium succinate once a day for 4 weeks, while normal saline solution in the control group. Rabbits were sacrificed at 0, 2, 4, and 8 weeks. Hip magnetic resonance imaging was performed before the rabbits were sacrificed. Serum calcium (Ca), phosphorus (P), total cholesterol, and triglyceride levels were also measured. The bone mineral density (BMD) of femoral head and the femoral shaft were measured by dual-energy X-ray absorptiometry. The trabecular parameters of the femur and the 4th lumbar vertebrae (L4) were measured with a micro-computed tomography (μ-CT). Also, the femoral head was stained with hematoxylin-eosin staining. Results: At 4 weeks in the GC group, the BMD of the femur reduced 33% and 22% in the femoral head and shaft; there was irregular intermediate to high T2-weighted images signals; μ-CT showed microfractures and cystic changes in the femoral head and L4 at 4 weeks. At 8 weeks in the GC group, the classical “line-like sign” indicating ON of the femoral head was observed

  2. Investigating Clinical Failure of Bone Grafting through a Window at the Femoral Head Neck Junction Surgery for the Treatment of Osteonecrosis of the Femoral Head

    PubMed Central

    Sun, Wei; Zhao, Dingyan; Gao, Fuqiang; Su, Yangming; Li, Zirong

    2016-01-01

    Aims This study aimed to analyze the clinical factors related to the failure of bone grafting through a window at the femoral head-neck junction. Methods In total, 119 patients (158 hips) underwent bone grafting for treatment of avascular necrosis of the femoral head. The patients were classified by their ARCO staging and CJFH classification. All patients were clinically and radiographically followed up every three months during the first year and every six months in the following year. The clinical follow-up comprised determination of pre- and postoperative Harris hip scores, while serial AP, frog lateral radiographs, and CT scan were used for the radiographic follow-up. Results The clinical failure of bone grafting was observed in 40 patients. The clinical failure rates in patients belonging to ARCO stage II period, IIIa, and III (b + c) were 25.9%, 16.2%, and 61.5%, respectively, while those in patients belonging to (C + M + L1) type and L2, L3 type disease groups were 1.7%, 38.9%, and 39%, respectively. The clinical failure rates in patients aged below 40 and those aged 40 and over were 20.5% and 39.0%, respectively (all P < 0.05). Conclusion Disease type, disease stage, and patient age are risk factors for failure of bone graft surgery. Patients belonging to ARCO stage II and IIIa showed a good overall response rate, while patients belonging to ARCO stage IIIb and IIIc and those with necrotic lesions involving the lateral pillar (L2 and L3 type) showed high surgical failure rates. PMID:27285821

  3. What Is Osteonecrosis?

    MedlinePlus

    ... always clear. Some known causes of osteonecrosis are: Steroid medications Alcohol use Injury Increased pressure inside the bone. Risk factors ... The cause, if known. If the cause is steroid or alcohol use, treatment may not work unless you stop using ...

  4. Osteonecrosis (Avascular Necrosis)

    MedlinePlus

    ... computed/computerized tomography) scans (see below), MRI detects chemical changes in the bone marrow. MRI provides the doctor ... a cross-section of the body. MRI detects chemical changes in the bone marrow and can show osteonecrosis ...

  5. Neuroelectromagnetic Forward Head Modeling Toolbox

    PubMed Central

    Acar, Zeynep Akalin; Makeig, Scott

    2014-01-01

    This paper introduces a Neuroelectromagnetic Forward Head Modeling Toolbox (NFT) running under MATLAB (The Mathworks, Inc.) for generating realistic head models from available data (MRI and/or electrode locations) and for computing numerical solutions for the forward problem of electromagnetic source imaging. The NFT includes tools for segmenting scalp, skull, cerebrospinal fluid (CSF) and brain tissues from T1-weighted magnetic resonance (MR) images. The Boundary Element Method (BEM) is used for the numerical solution of the forward problem. After extracting segmented tissue volumes, surface BEM meshes can be generated. When a subject MR image is not available, a template head model can be warped to measured electrode locations to obtain an individualized head model. Toolbox functions may be called either from a graphic user interface compatible with EEGLAB (http://sccn.ucsd.edu/eeglab), or from the MATLAB command line. Function help messages and a user tutorial are included. The toolbox is freely available under the GNU Public License for noncommercial use and open source development. PMID:20457183

  6. Model of beam head erosion

    SciTech Connect

    Lee, E.P.

    1980-08-08

    An analytical model of beam head dynamics is presented, leading to an estimate of the erosion rate due to the combined effects of Ohmic dissipation and scattering. Agreement with the results of a computer simulation and detailed one-dimensional computations is good in all respects except for the scaling of the erosion rate with net current.

  7. Animal Models of Head Trauma

    PubMed Central

    Cernak, Ibolja

    2005-01-01

    Summary: Animal models of traumatic brain injury (TBI) are used to elucidate primary and secondary sequelae underlying human head injury in an effort to identify potential neuroprotective therapies for developing and adult brains. The choice of experimental model depends upon both the research goal and underlying objectives. The intrinsic ability to study injury-induced changes in behavior, physiology, metabolism, the blood/tissue interface, the blood brain barrier, and/or inflammatory- and immune-mediated responses, makes in vivo TBI models essential for neurotrauma research. Whereas human TBI is a highly complex multifactorial disorder, animal trauma models tend to replicate only single factors involved in the pathobiology of head injury using genetically well-defined inbred animals of a single sex. Although such an experimental approach is helpful to delineate key injury mechanisms, the simplicity and hence inability of animal models to reflect the complexity of clinical head injury may underlie the discrepancy between preclinical and clinical trials of neuroprotective therapeutics. Thus, a search continues for new animal models, which would more closely mimic the highly heterogeneous nature of human TBI, and address key factors in treatment optimization. PMID:16389305

  8. ACR Appropriateness Criteria Osteonecrosis of the Hip.

    PubMed

    Murphey, Mark D; Roberts, Catherine C; Bencardino, Jenny T; Appel, Marc; Arnold, Erin; Chang, Eric Y; Dempsey, Molly E; Fox, Michael G; Fries, Ian Blair; Greenspan, Bennett S; Hochman, Mary G; Jacobson, Jon A; Mintz, Douglas N; Newman, Joel S; Rosenberg, Zehava S; Rubin, David A; Small, Kirstin M; Weissman, Barbara N

    2016-02-01

    Osteonecrosis of the hip (Legg-Calvé-Perthes) is a common disease, with 10,000-20,000 symptomatic cases annually in the United States. The disorder affects both adults and children and is most frequently associated with trauma and corticosteroid usage. The initial imaging evaluation of suspected hip osteonecrosis is done using radiography. MRI is the most sensitive and specific imaging modality for diagnosis of osteonecrosis of the hip. The clinical significance of hip osteonecrosis is dependent on its potential for articular collapse. The likelihood of articular collapse is significantly increased with involvement of greater than 30%-50% of the femoral head area, which is optimally evaluated by MRI, often in the sagittal plane. Contrast-enhanced MRI may be needed to detect early osteonecrosis of the hip in pediatric patients, revealing hypoperfusion. In patients with a contraindication for MRI, use of either CT or bone scintigraphy with SPECT (single-photon emission CT) are alternative radiologic methods of assessment. Imaging helps guide treatment, which may include core decompression, osteotomy, and ultimately, need for joint replacement. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26846390

  9. Effect of Osteonecrosis Intervention Rod Versus Core Decompression Using Multiple Small Drill Holes on Early Stages of Necrosis of the Femoral Head: A Prospective Study on a Series of 60 Patients with a Minimum 1-Year-Follow-Up

    PubMed Central

    Miao, Haixiong; Ye, Dongping; Liang, Weiguo; Yao, Yicun

    2015-01-01

    Introduction: The conventional CD used 10 mm drill holes associated with a lack of structural support. Thus, alternative methods such as a tantalum implant, small drill holes, and biological treatment were developed to prevent deterioration of the joint. The treatment of CD by multiple 3.2 mm drill holes could reduce the femoral neck fracture and partial weight bearing was allowed. This study was aimed to evaluate the effect of osteonecrosis intervention rod versus core decompression using multiple small drill holes on early stages of necrosis of the femoral head. Method: From January 2011 to January 2012, 60 patients undergoing surgery for osteonecrosis with core decompression were randomly assigned into 2 groups based on the type of core decompression used: (1) a total of 30 osteonecrosis patients (with 16 hips on Steinburg stageⅠ,20 hips on Steinburg stageⅡ) were treated with a porous tantalum rod insertion. The diameter of the drill hole for the intervention rod was 10mm.(2) a total of 30 osteonecrosis patients (with 14 hips on Steinburg stageⅠ,20 hips on Steinburg stageⅡ) were treated with core decompression using five drill holes on the lateral femur, the diameter of the hole was 3.2 mm. The average age of the patient was 32.6 years (20-45 years) and the average time of follow-up was 25.6 months (12- 28 months) in the rod implanted group. The average age of the patient was 35.2 years (22- 43 years) and the average time of follow-up was 26.3 months (12-28 months) in the small drill holes group. Results: The average of surgical time was 40 min, and the mean volume of blood loss was 30 ml in both surgical groups. The average of Harris score was improved from 56.2 ± 7.1 preoperative to 80.2 ± 11.4 at the last follow-up in the rod implanted group (p < 0.05). The mean Harris score was improved from 53.8 ± 6.6 preoperative to 79.7 ± 13.2 at the last follow-up in the small drill holes group (p<0. 05). No significant difference was observed in Harris score

  10. [Lingual mandibular osteonecrosis].

    PubMed

    de Visscher, J G A M; Dietvorst, D P; van der Meij, E H

    2013-04-01

    A 47-year-old man was referred to an oral and maxillofacial surgeon by his dentist because ofa painful ulcer with exposed bone at the lingual side of teeth 47 and 48. The lesion was diagnosed as lingual mandibular osteonecrosis. Characteristics of lingual mandibular osteonecrosis are exposed bone in the molar area and sequestration. The disorder can appear spontaneously or following damage to the mucous membrane. Treatment options are surgical smoothening of exposed bone, surgical removal of necrotic bone and awaiting spontaneous sequestration. PMID:23654048

  11. Establishment of an Animal Model of Bisphosphonate-Related Osteonecrosis of the Jaws in Spontaneously Diabetic Torii Rats

    PubMed Central

    Takaoka, Kazuki; Yamamura, Michiyo; Nishioka, Toshihiro; Abe, Tetsuya; Tamaoka, Joji; Segawa, Emi; Shinohara, Masami; Ueda, Haruyasu; Kishimoto, Hiromitsu; Urade, Masahiro

    2015-01-01

    Background We evaluated the side effects of bisphosphonate (BP) on tooth extraction socket healing in spontaneously diabetic Torii (SDT) rats, an established model of non-obese type 2 diabetes mellitus, to develop an animal model of BP-related osteonecrosis of the jaws (BRONJ). Materials and Methods Male Sprague-Dawley (SD) rats and SDT rats were randomly assigned to the zoledronic acid (ZOL)-treated groups (SD/ZOL or SDT/ZOL) or to the control groups (SD/control or SDT/control). Rats in the SD/ZOL or SDT/ZOL groups received an intravenous bolus injection of ZOL (35 μg/kg) every 2 weeks. Each group consisted of 6 rats each. Twenty-one weeks after ZOL treatment began, the left maxillary molars were extracted. The rats were euthanized at 2, 4, or 8 weeks after tooth extraction, and the total maxillae were harvested for histological and histochemical studies. Results In the oral cavity, bone exposure persisted at the tooth extraction site in all rats of the SDT/ZOL group until 8 weeks after tooth extraction. In contrast, there was no bone exposure in SD/control or SDT/control groups, and only 1 of 6 rats in the SD/ZOL group showed bone exposure. Histologically, necrotic bone areas with empty lacunae, microbial colonies, and less invasion by inflammatory cells were observed. The number of tartrate-resistant acid phosphatase-positive osteoclasts was lower in the SDT/ZOL group than in the SD/control group. The mineral apposition rate was significantly lower in the SDT/ZOL group compared with the SD/control group. Conclusions This study demonstrated the development of BRONJ-like lesions in rats and suggested that low bone turnover with less inflammatory cell infiltration plays an important role in the development of BRONJ. PMID:26659123

  12. ALL and osteonecrosis.

    PubMed

    Gaynon, Paul S

    2015-10-01

    In this issue of Blood, Karol et al establish a link between glutamate receptor polymorphisms and osteonecrosis, using a large discovery cohort and 2 validation cohorts. One validation cohort included patients under treatment of acute lymphoblastic leukemia (ALL) and the second is patients receiving glucocorticoid treatment of various other indications. PMID:26450951

  13. Clinical Results of Auto-Iliac Cancellous Bone Grafts Combined with Implantation of Autologous Bone Marrow Cells for Osteonecrosis of the Femoral Head: A Minimum 5-Year Follow-Up

    PubMed Central

    Kang, Joon Soon; Moon, Kyoung Ho; Kim, Bom-Soo; Shin, Sang Hyun; Shin, Byung Ki; Ryu, Dong-Jin

    2013-01-01

    Purpose There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH. Materials and Methods Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis. Results At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results. Conclusion The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions, this procedure generated clinical results comparable to those of other head preserving procedures. PMID:23364989

  14. [Aseptic bone flap osteonecrosis following cranioplasty after decompressive cranietomy].

    PubMed

    Smoll, Nicolas R; Stienen, Martin N; Schaller, Karl; Gautschi, Oliver P

    2013-06-19

    This case report discusses a case of aseptic osteonecrosis in a cranioplasty bone flap after decompressive craniectomy, which is a known, but rare complication after autologous cranioplasty. We suggest that the pathophysiology of cranial bone flap necrosis may have a similar pathophysiology to free flap necrosis/failure. The key suggested problem causing the osteonecrosis is vessel thrombosis within the smaller vessels of the bone flap due to the prothrombotic effects of the factors released during drilling of the bone flap. Suspicious local findings like wound dehiscence or fluid leakage should lead to a head computed tomography in order to discuss a prophylactic artificial second cranioplasty if necessary. PMID:23773942

  15. The Role of 99mTc-Annexin V Apoptosis Scintigraphy in Visualizing Early Stage Glucocorticoid-Induced Femoral Head Osteonecrosis in the Rabbit

    PubMed Central

    Wang, Xiaolong; Liu, Yu; Wang, Xuemei; Liu, Rui; Li, Jianbo; Zhang, Guoliang; Li, Qiang; Wang, Lei; Bai, Zhigang; Zhao, Jianmin

    2016-01-01

    Objective. To validate the ability of 99mTc-Annexin V to visualize early stage of glucocorticoid-induced femoral head necrosis by comparing with 99mTc-MDP bone scanning. Methods. Femoral head necrosis was induced in adult New Zealand white rabbits by intramuscular injection of methylprednisolone. 99mTc-Annexin scintigraphy and 99mTc-MDP scans were performed before and 5, 6, and 8 weeks after methylprednisolone administration. Rabbits were sacrificed at various time points and conducted for TUNEL and H&E staining. Results. All methylprednisolone treated animals developed femoral head necrosis; at 8 weeks postinjection, destruction of bone structure was evident in H&E staining, and apoptosis was confirmed by the TUNEL assay. This was matched by 99mTc-Annexin V images, which showed a significant increase in signal over baseline. Serial 99mTc-Annexin V scans revealed that increased 99mTc-Annexin V uptake could be observed in 5 weeks. In contrast, there was no effect on 99mTc-MDP signal until 8 weeks. The TUNEL assay revealed that bone cell apoptosis occurred at 5 weeks. Conclusion. 99mTc-Annexin V is superior to 99mTc-MDP for the early detection of glucocorticoid-induced femoral head necrosis in the rabbit and may be a better strategy for the early detection of glucocorticoid-induced femoral head necrosis in patients. PMID:26989689

  16. The efficacy of targeted intraarterial delivery of concentrated autologous bone marrow containing mononuclear cells in the treatment of osteonecrosis of the femoral head: A five year follow-up study

    PubMed Central

    Mao, Qiang; Jin, Hongting; Liao, Fei; Xiao, Luwei; Chen, Di; Tong, Peijian

    2014-01-01

    Objective To investigate the efficacy and safety of targeted delivery of autologous bone marrow mononuclear cells (BMMCs), which are highly enriched with mesenchymal stem cells (BMMSCs), via medial circumflex femoral artery in the treatment of osteonecrosis of the femoral head (ONFH). Methods 62 patients (78 hips) with ONFH were recruited in this study. All of these patients were treated with BMMCs perfusion via medial circumflex femoral artery. The concentrated BMMCs (30–60 ml) were gained from autologous bone marrow (100–200 ml) harvested from anterior iliac crest and then were intra-arterially perfused into the femoral head. Ficat stage was used to classify the radiological stage of ONFH. Harris hip score was used to evaluate the clinical symptoms of osteonecrosis. Ficat stage and Harris hip scores were assessed at onset of treatment at 6, 12, 24, 36, 48 and 60 months after the initial treatment. Total hip arthroplasty (THA) was also assessed as an endpoint at each follow-up. Results A follow-up on the patient was done at the end of five years, and 92.31% (72 of 78) of hips achieved a satisfactory clinical result while only 6 hips (7.69%) progressed to clinical failure and required THA. Radiological progression was noted in 34 of 78 hips (43.59%); the overall rate of collapse was 38.24% (26 of 68 hips) in stage-I and stage-II hip combinations and 12.5% (2 of 16)in stage-I hips and 46.15% (24 of 52) in stage-II hips. The mean time of conversion to THA was 3 years (1 to 5 years) and the average time to collapse were 3.5 years (1–5 years). The mean Harris hip score increased from 59 points at baseline to 75 points at 12 months, 82 points at 24 months, 81 points at 36 months, 79 points at 48 months and 74 points at 60 months. Five years after the treatment, 3 of 10 hips (30%) in stage-III had deteriorated to clinical failure whereas only 3 of 68 hips (4.41%) in stage-I and II combination had progressed to clinical failure (p < 0.05). Kaplan–Meier survival

  17. Factors associated with osteonecrosis of the jaw among bisphosponate users

    PubMed Central

    Hess, Lisa M; Jeter, Joanne M; Benham-Hutchins, Marge; Alberts, David S.

    2008-01-01

    Background Bisphosphonates are medications that impact bone reformation by inhibiting osteoclast function. Osteonecrosis of the jaw has been reported among patients receiving these medications. It is unclear if the risk factors associated with osteonecrosis of the jaw among cancer patients taking bisphosphonates are also possible risk factors among patients receiving these medications for other indications. Methods A systematic review search strategy was used to identify cases of osteonecrosis of the jaw among patients taking bisphosphonates for an indication other than cancer to identify potential contributing factors. Data were analyzed according to previous models to develop a more expanded model that may explain possible mechanisms for the development of osteonecrosis of the jaw among patients without cancer. Results Ninety-nine cases of osteonecrosis of the jaw were identified among patients who were prescribed a bisphosphonate for an indication other than cancer. These cases included 85 osteoporosis patients, 10 patients with Paget’s disease, two patients with rheumatoid arthritis, one patient with diabetes and one patient with maxillary fibrous dysplasia. The mean age was 69.4 years, 87.3% were female, and 87.6% were receiving oral, but not intravenous, bisphosphonates. Of the 63 patients reporting dental care information, 88.9% had a dental procedure prior to the onset of osteonecrosis of the jaw. Of all cases providing medical information, 71% were taking at least one medication that affects bone turnover in addition to the bisphosphonate, and 81.6% reported additional underlying health conditions. Conclusions The case details suggest a multiplicity of factors associated with this condition and provide the foundation for a model outlining the potential mechanism for the development of osteonecrosis of the jaw among patients taking bisphosphonates for an indication other than cancer. PMID:18501224

  18. Osteonecrosis of Femoral Head Treated with Extracorporeal Shock Wave Therapy: Analysis of Short-term Clinical Outcomes of Treatment with Radiologic Staging

    PubMed Central

    Lee, Jin-Young; Kwon, Jae-Woo; Park, Jung-Seob; Han, Kyeol; Shin, Woo-jin; Lee, Jeong-Gil

    2015-01-01

    Purpose To evaluate clinical results of extracorporeal shock wave therapy (ESWT) with radiographic staging on patients with avascular necrosis of femoral head (AVNFH). Materials and Methods We evaluated 24 patients diagnosed with AVNFH (32 hip joints) who were treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and the average age of patients was 47.8 years. The Association Research Circulation Osseous (ARCO) system was used to grade radiographic stage prior to treatment. For this study patients were divided into two groups based on their ARCO stage, group 1 (ARCO stages I and II) and group 2 (ARCO stage III). Comparative analyses were done between the two groups using the visual analogue scale (VAS) score and the Harris hip score (HHS) at pre-treatment and 3, 6, 12, and 24 months after treatment. Failure was defined when radiographic stage progressed or arthroplasty surgery was needed due to clinical exacerbation. Results Both groups showed clinical improvements with VAS scoring at final follow-up (group 1: median 7 to 1.5, P<0.001; group 2: mean 7 to 4, P=0.056). Using HHS, group 1 showed a significant improvement (from 65.5 to 95 [P<0.001]), while no significance was observed for group 2 (P=0.280). At final follow-up, 3 hips from group 1 and one hip from group 2 showed radiographic improvement; however, two patients underwent total hip arthroplasty due to persistent pain and dysfunction. Conclusion ESWT can be considered as an interventional option before surgical treatment in patients with not only early stage AVNFH but also with mid stage. PMID:27536633

  19. Hydrogen-rich saline attenuates steroid-associated femoral head necrosis through inhibition of oxidative stress in a rabbit model

    PubMed Central

    HUANG, SHENG-LI; JIAO, JIAN; YAN, HONG-WEI

    2016-01-01

    A growing body of evidence suggests that hydrogen is a novel, selective antioxidant that exerts a protective effect against organ damage. The present study investigated the effect of hydrogen-rich saline on corticosteroid-induced necrosis of the femoral head in an animal model established using prednisolone. A total of 30 healthy, male, adult New Zealand white rabbits were randomly divided into two groups: Hydrogen-rich saline (treated with hydrogen-rich saline via intraperitoneal injection) and placebo (treated with normal saline). At the set time-points, the structure of the femoral head was examined using a microscope; the concentrations of glutathione (GSH), lipid peroxide (LPO), vascular endothelial growth factor (VEGF) and thrombomodulin (TM) in the plasma were measured and the microvessel density was quantified. The results showed that hydrogen-rich saline significantly decreased the levels of VEGF, TM and LPO and increased the GSH level in steroid-associated necrosis of the femoral head in the rabbit model. A significant increase in the microvessel density was observed in the hydrogen-rich saline group. Histopathological staining confirmed the results of the biochemical analysis. The present study demonstrates that hydrogen treatment may alleviate steroid-associated osteonecrosis by inhibiting oxidative stress. Hydrogen-rich saline may provide an alternative treatment for steroid-associated necrosis of the femoral head. PMID:26889236

  20. The pathogenesis of multifocal osteonecrosis

    PubMed Central

    Sun, Wei; Shi, Zhencai; Gao, Fuqiang; Wang, Bailiang; Li, Zirong

    2016-01-01

    Our objective was to study the incidence, etiology, and diagnosis of multifocal osteonecrosis (MFON) and its treatment options to facilitate an earlier diagnosis and to optimize treatment. A radiological investigation was performed in osteonecrosis patients with a high risk of MFON for a more accurate diagnosis between January 2010 and June 2015. For patients with osteonecrosis of both the hip and knee joints or for patients with a history of corticosteroid use or alcohol abuse who had osteonecrosis of one or more joints in the shoulder, ankle, wrist or elbow, magnetic resonance imaging (MRI) was also performed on other joints, regardless of whether these joints were symptomatic. Furthermore, we performed a radiological screening of 102 patients who had a negative diagnosis of MFON but were at a high risk; among them, another 31 MFON cases were successfully identified (30.4%). Thus, the incidence of MFON during the study period increased from 3.1% to 5.2%. Patients diagnosed with osteonecrosis and who are at a high risk of MFON should have their other joints radiologically examined when necessary. This will reduce missed diagnosis of MFON and facilitate an earlier diagnosis and treatment to achieve an optimal outcome. PMID:27404962

  1. Osteonecrosis of the knee: review

    PubMed Central

    Karim, Ammar R.; Cherian, Jeffrey J.; Jauregui, Julio J.; Pierce, Todd

    2015-01-01

    Osteonecrosis is a devastating disease that can lead to end-stage arthritis of various joint including the knee. There are three categories of osteonecrosis that affect the knee: spontaneous osteonecrosis of the knee (SONK), secondary, and post-arthroscopic. Regardless of osteonecrosis categories, the treatment of this disease aims to halt further progression or delay the onset of end-stage arthritis of the knee. However, once substantial joint surface collapse has occurred or there are sign of degenerative arthritis, joint arthroplasty is the most appropriate treatment option. Currently, the non-operative treatment options consist of observation, non-steroidal anti-inflammatory drugs (NSAIDs), protected weight bearing, and analgesia as needed. Operative interventions include joint preserving surgery, unilateral knee arthroplasty (UKA), or total knee arthroplasty (TKA) depending on the extent and type of disease. Joint preserving procedures (i.e., arthroscopy, core decompression, osteochondral autograft, and bone grafting) are usually attempted in pre-collapse and some post-collapse lesions, when the articular cartilage is generally intact with only the underlying subchondral bone being affected. Conversely, after severe subchondral collapse has occurred, procedures that attempt to salvage the joint are rarely successful and joint arthroplasty are necessary to relieve pain. The purpose of this article is to highlight the recent evidence concerning the treatment options across the spectrum of management of osteonecrosis of the knee including lesion observation, medications, joint preserving techniques, and total joint arthroplasties. PMID:25705638

  2. The pathogenesis of multifocal osteonecrosis.

    PubMed

    Sun, Wei; Shi, Zhencai; Gao, Fuqiang; Wang, Bailiang; Li, Zirong

    2016-01-01

    Our objective was to study the incidence, etiology, and diagnosis of multifocal osteonecrosis (MFON) and its treatment options to facilitate an earlier diagnosis and to optimize treatment. A radiological investigation was performed in osteonecrosis patients with a high risk of MFON for a more accurate diagnosis between January 2010 and June 2015. For patients with osteonecrosis of both the hip and knee joints or for patients with a history of corticosteroid use or alcohol abuse who had osteonecrosis of one or more joints in the shoulder, ankle, wrist or elbow, magnetic resonance imaging (MRI) was also performed on other joints, regardless of whether these joints were symptomatic. Furthermore, we performed a radiological screening of 102 patients who had a negative diagnosis of MFON but were at a high risk; among them, another 31 MFON cases were successfully identified (30.4%). Thus, the incidence of MFON during the study period increased from 3.1% to 5.2%. Patients diagnosed with osteonecrosis and who are at a high risk of MFON should have their other joints radiologically examined when necessary. This will reduce missed diagnosis of MFON and facilitate an earlier diagnosis and treatment to achieve an optimal outcome. PMID:27404962

  3. Focal cryogen insults for inducing segmental osteonecrosis: computational and experimental assessments of thermal fields.

    PubMed

    Reed, Karen L; Brown, Thomas D; Conzemius, Michael G

    2003-09-01

    Orthopaedic management of femoral head osteonecrosis is a common clinical problem for which there presently is no good solution. Current animal models are inappropriate to study potential new solutions, since it has been difficult to replicate the natural history of structural collapse seen in the human disorder. Recently, progression to collapse was obtained for cryogenically induced osteonecrosis in emus, although the lesions involved were imprecisely controlled in terms of size or location. A new cryo-insult probe is here reported for the purpose of delivering well-prescribed local thermal insults in this new animal model, while minimizing damage to non-targeted regions. Finite element analysis was used to elucidate the influence of operator-controlled parameters upon the temporal/spatial variation of the thermal field. The numerical formulation includes convective heat transfer attributable to tissue bed perfusion. The computational results agreed closely with the results of thermocouple recordings in a companion bench-top experiment. The cryo-insult probe successfully produced segmental lesions in the emu model of sizes comparable to the computed freeze front diameters. PMID:12893040

  4. Bone SPECT/CT of Femoral Head Subchondral Insufficiency Fracture.

    PubMed

    Motomura, Goro; Yamamoto, Takuaki; Karasuyama, Kazuyuki; Iwamoto, Yukihide

    2015-09-01

    Subchondral insufficiency fracture of the femoral head may be confused with osteonecrosis, mainly because of radiological overlap. SPECT/CT with Tc-99 m hydroxymethylene diphosphonate images in 7 patients with subchondral insufficiency fracture were retrospectively reviewed and compared with those from 11 patients with symptomatic early osteonecrosis. In all of the hips with subchondral insufficiency fracture, SPECT/CT showed increased uptake at the subchondral lesions of the femoral head. On the other hand, in all of the hips with osteonecrosis, absence of uptake was confirmed at the subchondral lesions. SPECT/CT may assist in differentiating subchondral insufficiency fracture from osteonecrosis. PMID:26164176

  5. Kinematics of a Head-Neck Model Simulating Whiplash

    ERIC Educational Resources Information Center

    Colicchia, Giuseppe; Zollman, Dean; Wiesner, Hartmut; Sen, Ahmet Ilhan

    2008-01-01

    A whiplash event is a relative motion between the head and torso that occurs in rear-end automobile collisions. In particular, the large inertia of the head results in a horizontal translation relative to the thorax. This paper describes a simulation of the motion of the head and neck during a rear-end (whiplash) collision. A head-neck model that…

  6. Glucocorticoid-Induced Osteoporosis and Osteonecrosis

    PubMed Central

    Weinstein, Robert S.

    2012-01-01

    SYNOPSIS Glucocorticoid administration is the most common cause of secondary osteoporosis and the leading cause of nontraumatic osteonecrosis. In patients receiving long-term therapy, glucocorticoids induce fractures in 30 to 50% and osteonecrosis in 9 to 40%. This article reviews glucocorticoid-induced osteoporosis and osteonecrosis addressing the risk factors, pathogenesis, evaluation, treatment, and uncertainties in the clinical management of these disorders. PMID:22877431

  7. Lipopolysaccharide aggravates bisphosphonate-induced osteonecrosis in rats.

    PubMed

    Sakaguchi, O; Kokuryo, S; Tsurushima, H; Tanaka, J; Habu, M; Uehara, M; Nishihara, T; Tominaga, K

    2015-04-01

    The pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is highly controversial. We have previously reported the development of osteonecrosis by periodontal pathogenic stimulation in the jaw and femur of rats treated with bisphosphonate. Since the major toxicity factor of Gram-negative bacteria is lipopolysaccharide (LPS), the present study aimed to evaluate the relationship between osteonecrosis and LPS in a rat model of BRON-like lesions. Seventeen male rats were injected subcutaneously with zoledronic acid weekly for 4 weeks and divided into three groups: LPS (LPS administered into the bone marrow of the mandible and femur) and LPS plus polymyxin B (PMB) and saline groups (given neutralized LPS with PMB or saline, respectively, using the same protocol). At 4 weeks after the procedure, harvested specimens were analyzed using histomorphology (n=5 from each group) and histochemistry (n=1 each from LPS and LPS plus PMB groups). There was a significantly wider area of osteonecrosis in the LPS group as compared to the saline and LPS plus PMB groups in both the mandible (P=0.030 and P=0.009, respectively) and femur (P=0.002 and P=0.020, respectively). Our results indicate that LPS stimulation is deeply involved in the development and promotion of BRON. PMID:25442743

  8. Evaluation of the therapeutic effects of conditioned media from mesenchymal stem cells in a rat bisphosphonate-related osteonecrosis of the jaw-like model.

    PubMed

    Ogata, Kenichi; Katagiri, Wataru; Osugi, Masashi; Kawai, Takamasa; Sugimura, Yukiko; Hibi, Hideharu; Nakamura, Seiji; Ueda, Minoru

    2015-05-01

    Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as an exposed necrotic bone in the oral cavity that does not heal after appropriate intervention for >8weeks with present or previous bisphosphonate treatment in the absence of radiotherapy. Until now, although several risk factors, including invasive dental procedures, infection, mechanical trauma to the jawbone, and concomitant use of immunosuppressive and chemotherapy drugs have been implicated in the etiology of BRONJ, its underlying mechanisms and treatments remain largely unknown. A study recently showed that intravenous administration of mesenchymal stem cells (MSCs) improved BRONJ, and it was hypothesized that paracrine effects by secretomes from MSCs are the main constituent. Here we used rat BRONJ models to examine the therapeutic effects with serum-free conditioned media from human MSCs (MSC-CM), including various secretomes. We showed that MSC-CM has protected rat MSCs and rat osteoclasts. MSC-CM enhanced the expression of osteogenic-related genes and neovascularization-related genes by real-time reverse-transcriptase polymerase chain reaction analysis in in vitro study. In in vivo study, 5-week-old Wistar/ST male rats received zoledronate (35μg/kg/week) and dexamethasone (1mg/kg/day) subcutaneously for 2weeks. Unilateral maxillary molars were then extracted. Two weeks later, rats were divided into non-treatment, serum-free Dulbecco's modified Eagle's medium, and MSC-CM groups. In the MSC-CM group, the open alveolar sockets in 63% of the rats with BRONJ healed with complete soft tissue coverage and socket bones, whereas the exposed necrotic bone with inflamed soft tissue remained in the other groups. Histological analysis showed new bone formation and the appearance of osteoclasts in the MSC-CM group. Osteoclasts were significantly reduced in the non-treatment group. Thus, we concluded that the antiapoptotic and antiinflammatory effects of MSC-CM dramatically regulated the turnover of

  9. A case of early detection of bisphosphonate-related osteonecrosis of the jaw.

    PubMed

    Mori, Miyu; Koide, Tetsuro; Matsui, Yuriyo; Matsuda, Toru

    2015-01-01

    Osteonecrosis of the jaws is an adverse reaction associated with the use of bisphosphonates. Although the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is based on symptomatology, it is often detected late because the patients become symptomatic only after osteonecrosis is well established. We describe a case of early oral BRONJ detected by magnetic resonance imaging (MRI) accidentally. Head MRI revealed low signal of T1-weight images in left mandibula. Patient had been treated with minodronate for osteoporosis during 18 months. Based on the MRI findings and medication history, early stage BRONJ could be considered. Therefore minodronate was switched to teriparatide. Thereafter mandible pares-thesias, odontalgia and exposed bone were not observed. This case suggests that MRI is useful for the early detection of BRONJ. PMID:26069377

  10. A case of early detection of bisphosphonate-related osteonecrosis of the jaw

    PubMed Central

    Mori, Miyu; Koide, Tetsuro; Matsui, Yuriyo; Matsuda, Toru

    2015-01-01

    Osteonecrosis of the jaws is an adverse reaction associated with the use of bisphosphonates. Although the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is based on symptomatology, it is often detected late because the patients become symptomatic only after osteonecrosis is well established. We describe a case of early oral BRONJ detected by magnetic resonance imaging (MRI) accidentally. Head MRI revealed low signal of T1-weight images in left mandibula. Patient had been treated with minodronate for osteoporosis during 18 months. Based on the MRI findings and medication history, early stage BRONJ could be considered. Therefore minodronate was switched to teriparatide. Thereafter mandible pares-thesias, odontalgia and exposed bone were not observed. This case suggests that MRI is useful for the early detection of BRONJ. PMID:26069377

  11. The role of hip arthroscopy in the management of osteonecrosis

    PubMed Central

    Papavasiliou, A.; Yercan, H. S.; Koukoulias, N.

    2014-01-01

    Hip arthroscopy has emerged as a diagnostic and therapeutic tool in the management of osteonecrosis (ON) of the femoral head. Direct visualization of the joint, aids the staging of the disease, while mechanical symptoms and pain can be alleviated by addressing the often coexisting intra-articular pathology (labral tears, chondral delamination, loose bodies and synovitis) thereby improving the clinical outcome in some patients. The article explores the role and possible value of hip arthroscopy as a surgical technique in the treatment of hip ON. PMID:27011804

  12. Modeling heading in adult soccer players.

    PubMed

    Ponce, Ernesto; Ponce, Daniel; Andresen, Max

    2014-01-01

    Heading soccer balls can generate mild brain injuries and in the long run can lead to difficulty in solving problems, memory deficits, and language difficulties. Researchers evaluated the effects on the head for both correct and incorrect heading techniques. They based the head's geometry on medical images. They determined the injury's magnitude by comparing the neurological tissue's resistance with predictions of the generated stresses. The evaluation examined fast playing conditions in adult soccer, taking into account the ball's speed and the type of impact. Mathematical simulations using the finite element method indicated that correctly heading balls arriving at moderate speed presents a low risk of brain injury. However, damage can happen around the third cervical vertebra. These results coincide with medical studies. Incorrect heading greatly increases the brain injury risk and can alter the parietal area. PMID:25248195

  13. The Apparent Critical Isotherm for Cryoinsult-Induced Osteonecrotic Lesions in Emu Femoral Heads

    PubMed Central

    Goetz, Jessica E.; Pedersen, Douglas R.; Robinson, Duane A.; Conzemius, Michael G.; Baer, Thomas E.; Brown, Thomas D.

    2008-01-01

    Cryoinsult-induced osteonecrosis (ON) in the emu femoral head provides a unique opportunity to systematically explore the pathogenesis of ON in an animal model that progresses to human-like femoral head collapse. Among the various characteristics of cryoinsult, the maximally cold temperature attained is one plausible determinant of tissue necrosis. To identify the critical isotherm required to induce development of osteonecrosis in the cancellous bone of the emu femoral head, a thermal finite element (FE) model of intraoperative cryoinsults was developed. Thermal material property values of emu cancellous bone were estimated from FE simulations of cryoinsult to emu cadaver femora, by varying model properties until the FE-generated temperatures matched corresponding thermocouple measurements. The resulting FE model, with emu-bone-specific thermal properties augmented to include blood flow effects, was then used to study intraoperatively performed in vivo cryoinsults. Comparisons of minimum temperatures attained at FE nodes corresponding to the three-dimensional histologically apparent boundary of the region of osteonecrosis were made for six experimental cryoinsults. Series-wide, a critical isotherm of 3.5°C best corresponded to the boundary of the osteonecrotic lesions. PMID:18561937

  14. What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis

    PubMed Central

    Minkalis, Amy L.; Vining, Robert D.

    2015-01-01

    Background: Low back pain is a common symptom arising from many possible sources and includes the possibility of the contribution of remote pathology. This report describes a patient with bilateral osteonecrosis of the femoral heads presenting with a primary symptom of low back pain. Case presentation: A 37-year-old male presented for evaluation of dominant pain that existed for approximately 6–12 months and was located in the right low back. Milder pain was also reported in the right hip. Low back and hip pain were both aggravated by weight-bearing activities. An evidence-based diagnostic evaluation revealed little indication for a primary pain source originating from low back structures. Radiographs revealed bilateral osteonecrosis with evidence of left femoral head collapse. Conclusion: Hip osteonecrosis may have contributed to an atypical presentation of low back pain due to aberrant localization of pain and/or combined with altered biomechanical loading of musculoskeletal structures. PMID:26500365

  15. The Texas Head Start Metro Models.

    ERIC Educational Resources Information Center

    Riley, Mary Tom, Ed.; Flores, Alfredo R., Ed.

    The Texas Metro Network (TMN) is an informal group of Head Start Directors and Executive Directors organized for the purposes of improving the delivery of training and technical assistance and for assisting communication between large scale Head Start programs in the metropolitan areas of Texas. In pursuit of these aims, each member unit of the…

  16. An internal model of head kinematics predicts the influence of head orientation on reflexive eye movements

    NASA Astrophysics Data System (ADS)

    Zupan, L. H.; Merfeld, D. M.

    2005-09-01

    Our sense of self-motion and self-orientation results from combining information from different sources. We hypothesize that the central nervous system (CNS) uses internal models of the laws of physics to merge cues provided by different sensory systems. Different models that include internal models have been proposed; we focus herein on that referred to as the sensory weighting model (Zupan et al 2002 Biol. Cybern. 86 209-30). For simplicity, we isolate the portion of the sensory weighting model that estimates head angular velocity: it includes an inverse internal model of head kinematics and an 'idiotropic' vector aligned with the main body axis. Following a post-rotatory tilt in the dark, which is a rapid tilt following a constant-velocity rotation about an earth-vertical axis, the inverse internal model is applied to conflicting vestibular signals. Consequently, the CNS computes an inaccurate estimate of head angular velocity that shifts toward alignment with an estimate of gravity. Since reflexive eye movements known as vestibulo-ocular reflexes (VOR) compensate for this estimate of head angular velocity, the model predicts that the VOR rotation axis shifts toward alignment with this estimate of gravity and that the VOR time constant depends on final head orientation. These predictions are consistent with experimental data.

  17. An internal model of head kinematics predicts the influence of head orientation on reflexive eye movements.

    PubMed

    Zupan, L H; Merfeld, D M

    2005-09-01

    Our sense of self-motion and self-orientation results from combining information from different sources. We hypothesize that the central nervous system (CNS) uses internal models of the laws of physics to merge cues provided by different sensory systems. Different models that include internal models have been proposed; we focus herein on that referred to as the sensory weighting model. For simplicity, we isolate the portion of the sensory weighting model that estimates head angular velocity: it includes an inverse internal model of head kinematics and an 'idiotropic' vector aligned with the main body axis. Following a post-rotatory tilt in the dark, which is a rapid tilt following a constant-velocity rotation about an earth-vertical axis, the inverse internal model is applied to conflicting vestibular signals. Consequently, the CNS computes an inaccurate estimate of head angular velocity that shifts toward alignment with an estimate of gravity. Since reflexive eye movements known as vestibulo-ocular reflexes (VOR) compensate for this estimate of head angular velocity, the model predicts that the VOR rotation axis shifts toward alignment with this estimate of gravity and that the VOR time constant depends on final head orientation. These predictions are consistent with experimental data. PMID:16135883

  18. Core decompression and labral support for the treatment of juvenile osteonecrosis.

    PubMed

    Herrera-Soto, Jose Antonio; Price, Charles T

    2011-09-01

    The final outcome of Legg-Calvé-Perthes disease is variable and depends mostly on the age of the patient at onset and the amount of femoral head involvement. The goals of treatment are to achieve a round femoral head with a congruous hip joint and to contain the femoral head to avoid extrusion. We will term this condition in the adolescent age, "juvenile osteonecrosis," as we understand that the osteonecrosis pattern responds differently to that in younger patients who develop Perthes and it is similar to adult osteonecrosis. Most of the deformity comes from the collapse and enlargement in size of the femoral head. Therefore, the treatment rationale should be tailored to address these differences. We believe that early core decompression combined with containment in the form of a shelf acetabuloplasty can change the natural history of the disease based on both adolescent and adult literature. The core allows removal of the necrotic segment; it improves vascularization to the affected area and may provide structural support in some cases. The shelf provides support to distribute the forces across the joint and prevents lateral migration. It also provides better acetabular roof to prevent early dysplastic changes that lead to arthritis. PMID:21857441

  19. Drug induced osteonecrosis of the jaw.

    PubMed

    Hamadeh, Issam S; Ngwa, Bridget A; Gong, Yan

    2015-05-01

    Despite the widespread use of bisphosphonates and their unequivocal efficacy for the treatment of various disease states, osteonecrosis of the jaw remains one of the most feared complications associated with their use. Current evidence, however, suggests that there is also a relationship between occurrence of osteonecrosis of the jaw and use of other classes of pharmacotherapies namely RANKL inhibitors as well as angiogenesis inhibitors. Although these drugs have different mechanisms of action than bisphosphonates, they all seem to interfere with the bone remodeling process i.e. alter the balance between bone resorption and bone formation which may be the most plausible explanation for pathogenesis of osteonecrosis of the jaw. The main objective of this review is to introduce the readership to a number of relatively new medications that may cause osteonecrosis of the jaw. Accordingly, we will summarize latest findings from clinical studies, meta analyses and case reports published in medical literature on this topic. For some of these medications, the evidence may not appear as robust as that for bisphosphonates; yet, the possibility of this adverse event occurring with these non bisphosphonate drugs should never be precluded unless proven otherwise. Thus, it is imperative that health care providers implement preventive measures so as to circumvent the incidence of osteonecrosis of the jaw. In this day of age where medical care is becoming personalized, we will highlight some of significant findings from studies seeking to identify genetic markers that may potentially play a role in development of osteonecrosis of the jaw. PMID:25913713

  20. Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress

    PubMed Central

    Trousselier, Matthieu; Roubineau, François; Bouthors, Charlie; Chevallier, Nathalie; Rouard, Helene; Flouzat-Lachaniette, Charles-Henri

    2016-01-01

    Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed as early as 1985 by the senior author (PH). We undertook a systematic review of the medical literature to examine the progress in cell therapy during the last 30 years for the treatment of early stage osteonecrosis. PMID:26929793

  1. [Osteonecrosis: natural course and conservative therapy].

    PubMed

    Hofmann, S; Mazières, B

    2000-05-01

    The natural course of Osteonecrosis (ON) of the femoral head has yet not been evaluated sufficiently. Especially in the early forms of the disease (ARCO 0 to II) without collapse of the femoral head, useful information on the natural course could only be collected since the routine use of MR-imaging. The unspecific findings in ARCO stage I with negative radiographs are potential reversible. The "point of no return" already lies in the irreversible ARCO stage II in almost all cases. Prognosis for further progression for both early stages depends primarily on the extension and location of the lesion. Only the rare, small to medium sized lesions in the medial or central location may have a good prognostic course over a period of more than five years. The much more common large sized and lateral located lesions will have a probability of about 80% to progress to femoral head collapse within two years. Conservative therapy with single protected weight bearing has shown bad results not significantly different from the natural course of the disease. Pulsed electromagnetic fields are still discussed controversially. Until now there is no MRI controlled study available in early ON, showing superior results compared to the easy and cost-effective core decompression therapy. The extra corporal shock wave therapy has shown spontaneous pain relief in early ON. Midterm results of this new therapeutical concept are not available yet. Hyperbaric oxygen therapy has shown to stimulate the repair process in an animal experiment. The preliminary clinical results of this time and cost consuming therapy are not convincing. Vasoactive drugs in combination with limited weight bearing may play a role in the conservative management of early ON (ARCO I and part of ARCO II) in the future. For the conservative therapy in ON several other substance are currently in clinical testing. The benefit of conservative therapeutical concepts in ON in the future can only be evaluated with prospective MRI

  2. A virtual model of the patient's head for BNCT

    NASA Astrophysics Data System (ADS)

    Tyminska, Katarzyna; Jezierski, Karol; Osko, Jakub

    2009-01-01

    The aim of the present work was creating a virtual phantom of a human head for BNCT, as a part of the BNCT programme project. This model is an amplification of the simple model described in earlier publications. It takes into account the major head organs as well as the scalp and skull. The chemical composition of all tissues was modelled according to the recommendations of the ICRP. The organs were parameterized using mathematical formulas based on the human head magnetic resonance images. The model was used for calculating the thermal neutron flux and the injuring (fast neutron, nitrogen and gamma) dose components for the head irradiated using the therapeutic neutron beam, whose parameters were obtained as the result of the modelling of the filter/moderator system for the BNCT therapeutic beam from the MARIA reactor.

  3. Head Motion Modeling for Human Behavior Analysis in Dyadic Interaction

    PubMed Central

    Xiao, Bo; Georgiou, Panayiotis; Baucom, Brian; Narayanan, Shrikanth S.

    2015-01-01

    This paper presents a computational study of head motion in human interaction, notably of its role in conveying interlocutors’ behavioral characteristics. Head motion is physically complex and carries rich information; current modeling approaches based on visual signals, however, are still limited in their ability to adequately capture these important properties. Guided by the methodology of kinesics, we propose a data driven approach to identify typical head motion patterns. The approach follows the steps of first segmenting motion events, then parametrically representing the motion by linear predictive features, and finally generalizing the motion types using Gaussian mixture models. The proposed approach is experimentally validated using video recordings of communication sessions from real couples involved in a couples therapy study. In particular we use the head motion model to classify binarized expert judgments of the interactants’ specific behavioral characteristics where entrainment in head motion is hypothesized to play a role: Acceptance, Blame, Positive, and Negative behavior. We achieve accuracies in the range of 60% to 70% for the various experimental settings and conditions. In addition, we describe a measure of motion similarity between the interaction partners based on the proposed model. We show that the relative change of head motion similarity during the interaction significantly correlates with the expert judgments of the interactants’ behavioral characteristics. These findings demonstrate the effectiveness of the proposed head motion model, and underscore the promise of analyzing human behavioral characteristics through signal processing methods. PMID:26557047

  4. Evaluation of a laboratory model of human head impact biomechanics.

    PubMed

    Hernandez, Fidel; Shull, Peter B; Camarillo, David B

    2015-09-18

    This work describes methodology for evaluating laboratory models of head impact biomechanics. Using this methodology, we investigated: how closely does twin-wire drop testing model head rotation in American football impacts? Head rotation is believed to cause mild traumatic brain injury (mTBI) but helmet safety standards only model head translations believed to cause severe TBI. It is unknown whether laboratory head impact models in safety standards, like twin-wire drop testing, reproduce six degree-of-freedom (6DOF) head impact biomechanics that may cause mTBI. We compared 6DOF measurements of 421 American football head impacts to twin-wire drop tests at impact sites and velocities weighted to represent typical field exposure. The highest rotational velocities produced by drop testing were the 74th percentile of non-injury field impacts. For a given translational acceleration level, drop testing underestimated field rotational acceleration by 46% and rotational velocity by 72%. Primary rotational acceleration frequencies were much larger in drop tests (~100 Hz) than field impacts (~10 Hz). Drop testing was physically unable to produce acceleration directions common in field impacts. Initial conditions of a single field impact were highly resolved in stereo high-speed video and reconstructed in a drop test. Reconstruction results reflected aggregate trends of lower amplitude rotational velocity and higher frequency rotational acceleration in drop testing, apparently due to twin-wire constraints and the absence of a neck. These results suggest twin-wire drop testing is limited in modeling head rotation during impact, and motivate continued evaluation of head impact models to ensure helmets are tested under conditions that may cause mTBI. PMID:26117075

  5. Osteonecrosis

    MedlinePlus

    ... American College of Rheumatology Committee on Communications and Marketing. Written by Susan Hylland, MD. This patient fact ... Lists Supporters About Us Leadership Careers at ACR Social Media Newsroom Annual Reports & Financial Statements Policies & Guidelines ...

  6. Osteonecrosis

    MedlinePlus

    ... Limited range of motion Groin pain, if the hip joint is affected Limping, if the condition occurs in ... 248. Read More Broken bone Dislocation Gaucher disease Hip joint replacement Knee joint replacement Radiation therapy Sickle cell ...

  7. Contact stress distributions on the femoral head of the emu (Dromaius novaehollandiae).

    PubMed

    Troy, Karen L; Brown, Thomas D; Conzemius, Michael G

    2009-11-13

    Osteonecrosis of the femoral head remains a challenging orthopaedic problem. The disease frequently progresses to femoral head collapse, leading to debilitating osteoarthritis in the affected hip(s). Since a major goal of pre-collapse interventions is to forestall the need for hip arthroplasty, it is important that any animal models used to develop or study such interventions also have a natural history of progression to femoral head collapse. The emu (Dromaius novaehollandiae), a large flightless bird native to Australia, consistently progresses to femoral head collapse when osteonecrosis is experimentally induced cryogenically. Full biomechanical characterization of the demands this animal places on its hip is an important consideration in future usage of this model. This study reports in vitro measurement of the contact stress distributions on the emu femoral head during stance phase of the gait cycle, using Fuji pressure-sensitive film. Applied hip loadings were based upon ground reaction forces and hip flexion angles recorded in vivo. The contact stress data showed reasonable homology with the human hip, both in terms of stress magnitude and sites of habitual loading on the femoral head. PMID:19665715

  8. [Bisphosphonate-related osteonecrosis of the jaw].

    PubMed

    Atanes-Bonome, P; Atanes-Bonome, A; Ríos-Lage, P; Atanes-Sandoval, A D

    2014-04-01

    The bisphosphonates are stable inorganic pyrophosphate analogs that have demonstrated their efficacy in treatment of osteolytic lesions associated with bony metastases, and multiple myeloma, malignant hypercalcemia, Paget's disease, and osteoporosis. Several publications within the last few years have suggested that osteonecrosis of the jaw is associated with bisphosphonate therapy. The diagnosis and management strategies of the patients with bisphosphonate-related osteonecrosis of the jaw is very difficult. It is important for patients to be informed of the risk of this complication, so that they have the opportunity to assess the need for dental treatment before starting therapy. Preventive measures must be taken before, during, and after treatment with bisphosphonates. If osteonecrosis of the jaw is present, management should be conservative: oral chlorhexidine and antibiotics. Surgical treatment should be reserved for those patients who are symptomatic. PMID:24001573

  9. Modeling polyethylene wear acceleration due to femoral head dislocation damage.

    PubMed

    Kruger, Karen M; Tikekar, Nishant M; Heiner, Anneliese D; Lannutti, John J; Callaghan, John J; Brown, Thomas D

    2014-08-01

    Scratching, scraping, and metal transfer to femoral heads commonly accompany acetabular shell contact during dislocation and closed reduction maneuvers. While head damage conceptually leads to accelerated wear, reports on this subject are mainly anecdotal, and differ widely on the potency of such effect. Towards better understanding this relationship, a physically validated finite element (FE) model was used to compute polyethylene wear acceleration propensity of specific head damage patterns on thirteen retrievals. These FE models estimated wear increases averaging half an order of magnitude when compared to simulations for undamaged heads. There was no correlation between the number of dislocations sustained and wear acceleration. These results underscore the importance of implant-gentle closed reduction, and heightened wear monitoring of successfully reduced dislocation patients. PMID:24851789

  10. Animal models of cancer in the head and neck region.

    PubMed

    Kim, Seungwon

    2009-06-01

    Animal models that resemble the cancers of the head and neck region are of paramount importance in studying the carcinogenesis of these diseases. Although several methods for modeling cancer in the head and neck are available, none are fully satisfactory. Subcutaneous xenograft models of cancer in nude mice are often used in preclinical studies. However, these models are problematic in several aspects as they lack the specific interactions that exist between the tumor cells and their native environment. Establishment of tumors at the orthotopic sites restore these distinct patterns of interactions between the tumor and the host organs that are lost or altered when the tumors are established in ectopic sites. With regard to the transgenic model of cancer in the head and neck region, it should be kept in mind that the transgene used to drive the malignant transformation may not be representative of the carcinogenic process found in human tumors. Low penetrance of tumor formation also translates into high cost and time commitment in performing studies with transgenic models. In this review, we will discuss some of the commonly used methods for modeling cancer in the head and neck region including squamous cell carcinoma of the head and neck as well as thyroid carcinoma. PMID:19565028

  11. Animal Models of Cancer in the Head and Neck Region

    PubMed Central

    2009-01-01

    Animal models that resemble the cancers of the head and neck region are of paramount importance in studying the carcinogenesis of these diseases. Although several methods for modeling cancer in the head and neck are available, none are fully satisfactory. Subcutaneous xenograft models of cancer in nude mice are often used in preclinical studies. However, these models are problematic in several aspects as they lack the specific interactions that exist between the tumor cells and their native environment. Establishment of tumors at the orthotopic sites restore these distinct patterns of interactions between the tumor and the host organs that are lost or altered when the tumors are established in ectopic sites. With regard to the transgenic model of cancer in the head and neck region, it should be kept in mind that the transgene used to drive the malignant transformation may not be representative of the carcinogenic process found in human tumors. Low penetrance of tumor formation also translates into high cost and time commitment in performing studies with transgenic models. In this review, we will discuss some of the commonly used methods for modeling cancer in the head and neck region including squamous cell carcinoma of the head and neck as well as thyroid carcinoma. PMID:19565028

  12. Short-Term Bisphosphonate Therapy Could Ameliorate Osteonecrosis: A Complication in Childhood Hematologic Malignancies

    PubMed Central

    Greggio, N. A.; Pillon, M.; Varotto, E.; Zanin, A.; Talenti, E.; Palozzo, A. C.; Calore, E.; Messina, C.

    2010-01-01

    Osteonecrosis (ON) is a critical complication in the treatment of childhood leukemia and lymphoma. It particularly affects survivors of acute lymphoblastic leukemia and non-Hodgkin lymphoma reflecting the cumulative exposure to glucocorticosteroid therapy. ON is often multiarticular and bilateral, specially affecting weight-bearing joints. A conventional approach suggests a surgical intervention even if pharmacological options have also recently been investigated. We reported two cases of long time steroid-treated patients who underwent Bone Marrow Transplantation (BMT) for hematological disease. Both patients developed femoral head osteonecrosis (ON) that was diagnosed by magnetic resonance imaging (MRI) and the ON was also accompanied with pain and a limp. Despite of the conventional strategies of therapy, we successfully started a short-term treatment with bisphosphonates in order to decrease the pain and the risk of fracture. PMID:20589085

  13. Inverse Modelling to Obtain Head Movement Controller Signal

    NASA Technical Reports Server (NTRS)

    Kim, W. S.; Lee, S. H.; Hannaford, B.; Stark, L.

    1984-01-01

    Experimentally obtained dynamics of time-optimal, horizontal head rotations have previously been simulated by a sixth order, nonlinear model driven by rectangular control signals. Electromyography (EMG) recordings have spects which differ in detail from the theoretical rectangular pulsed control signal. Control signals for time-optimal as well as sub-optimal horizontal head rotations were obtained by means of an inverse modelling procedures. With experimentally measured dynamical data serving as the input, this procedure inverts the model to produce the neurological control signals driving muscles and plant. The relationships between these controller signals, and EMG records should contribute to the understanding of the neurological control of movements.

  14. An FDTD model of scattering from meteor head plasma

    NASA Astrophysics Data System (ADS)

    Marshall, R. A.; Close, S.

    2015-07-01

    We have developed a three-dimensional finite difference time domain (FDTD) model of scattering of radar waves from meteor head plasma. The model treats the meteor head plasma as a cold, collisional, and magnetized plasma, and solves Maxwell's equations and the Langevin equation simultaneously and self-consistently in and around the plasma. We use this model to investigate scattering of radar waves from a meteor head (the "head echo") under a range of plasma densities, meteor scale sizes, and wave frequencies. In this way we relate the radar cross section (RCS) to these variable parameters. We find that computed RCS disagrees with previous analytical theory at certain meteor sizes and densities, in some cases by over an order of magnitude. We find that the calculated meteor head RCS is monotonically related to the "overdense area" of the meteor, defined as the cross-section area of the part of the meteor where the plasma frequency exceeds the wave frequency. These results provides a physical measure of the meteor size and density that can be inferred from measured RCS values from ground-based radars. Meteoroid mass can then be inferred from the meteor plasma distribution using established methods.

  15. A revised dosimetric model of the adult head and brain

    SciTech Connect

    Bouchet, L.G.; Bolch, W.E.; Weber, D.A.

    1996-06-01

    During the last decade, new radiopharmaceutical have been introduced for brain imaging. The marked differences of these tracers in tissue specificity within the brain and their increasing use for diagnostic studies support the need for a more anthropomorphic model of the human brain and head. Brain and head models developed in the past have been only simplistic representations of this anatomic region. For example, the brain within the phantom of MIRD Pamphlet No. 5 Revised is modeled simply as a single ellipsoid of tissue With no differentiation of its internal structures. To address this need, the MIRD Committee established a Task Group in 1992 to construct a more detailed brain model to include the cerebral cortex, the white matter, the cerebellum, the thalamus, the caudate nucleus, the lentiform nucleus, the cerebral spinal fluid, the lateral ventricles, and the third ventricle. This brain model has been included within a slightly modified version of the head model developed by Poston et al. in 1984. This model has been incorporated into the radiation transport code EGS4 so as to calculate photon and electron absorbed fractions in the energy range 10 keV to 4 MeV for each of thirteen sources in the brain. Furthermore, explicit positron transport have been considered, separating the contribution by the positron itself and its associated annihilations photons. No differences are found between the electron and positron absorbed fractions; however, for initial energies of positrons greater than {approximately}0.5 MeV, significant differences are found between absorbed fractions from explicit transport of annihilation photons and those from an assumed uniform distribution of 0.511-MeV photons. Subsequently, S values were calculated for a variety of beta-particle and positron emitters brain imaging agents. Moreover, pediatric head and brain dosimetric models are currently being developed based on this adult head model.

  16. A revised dosimetric model of the adult head and brain

    SciTech Connect

    Bouchet, L.G.; Bolch, W.E.; Weber, D.A.; Atkins, H.L.; Poston, J.W. ||

    1996-07-01

    During the last decade, several new radiopharmaceuticals have been introduced for brain imaging. The marked differences of these tracers in tissue specificicity within the brain and their increasing use for diagnostic studies support the need for a more antihropomorphic model of the human brain and head. Brain and head models developed in the past have comprised only simplistic representations of this anatomic region. A new brain model has been developed which includes eight subregions: the caudate nucleus, the cerebellium, the cerebral cortex, the lateral ventricles, the lentiform nucleus, the thalamus, the third ventricle and the white matter. This brain model has been included within a slightly modified version of the head model developed by Poston et al. in 1984. The head model, which includes both the thyroid and eyes, was modified in this work to include the cerebrospinal fluid within the cranial and spinal regions. Absorbed fractions of energy for photon and electron sources located in thirteen source regions within the new head model were calculated using the EGS4 Monte Carlo radiation transport code for radiations in the energy range 10 keV to 4 MeV. S-values were calculated for five radionuclides used in brain imaging ({sup 11}C, {sup 15}O, {sup 18}F, {sup 99m}Tc and {sup 123}I) and for three radionuclides showing selective uptake in the thyroid ({sup 99m}Tc, {sup 123}I, and {sup 131}I). S-values were calculated using 100 discrete energy points in the beta-emission spectrum of the different radionuclides. 17 refs., 14 figs., 3 tabs.

  17. Computer model of catalytic combustion/Stirling engine heater head

    NASA Technical Reports Server (NTRS)

    Chu, E. K.; Chang, R. L.; Tong, H.

    1981-01-01

    The basic Acurex HET code was modified to analyze specific problems for Stirling engine heater head applications. Specifically, the code can model: an adiabatic catalytic monolith reactor, an externally cooled catalytic cylindrical reactor/flat plate reactor, a coannular tube radiatively cooled reactor, and a monolithic reactor radiating to upstream and downstream heat exchangers.

  18. Torus Palatinus Osteonecrosis Related to Bisphosphonate: A Case Report

    PubMed Central

    Godinho, Mariana; Barbosa, Fabio; Andrade, Felipe; Cuzzi, Tullia; Ramos-e-Silva, Marcia

    2013-01-01

    Introduction Osteonecrosis of the palate is a rare condition which is even rarer when occurring on a torus palatinus and associated with bisphosphonate (BP). Case Presentation We report an uncommon case of osteonecrosis of a torus palatinus. Our patient was a 67-year-old white female who presented with a painful intraoral ulcer associated with necrotic bone tissue of her torus palatinus, due to the chronic use of alendronate. Conclusion We point out the possible causative relationship of BPs and osteonecrosis on torus growth. It is very important to know that torus palatinus and the use of BPs are risk factors for osteonecrosis of the maxilla. PMID:23687490

  19. Ranking Medical Subject Headings using a factor graph model

    PubMed Central

    Wei, Wei; Demner-Fushman, Dina; Wang, Shuang; Jiang, Xiaoqian; Ohno-Machado, Lucila

    2015-01-01

    Automatically assigning MeSH (Medical Subject Headings) to articles is an active research topic. Recent work demonstrated the feasibility of improving the existing automated Medical Text Indexer (MTI) system, developed at the National Library of Medicine (NLM). Encouraged by this work, we propose a novel data-driven approach that uses semantic distances in the MeSH ontology for automated MeSH assignment. Specifically, we developed a graphical model to propagate belief through a citation network to provide robust MeSH main heading (MH) recommendation. Our preliminary results indicate that this approach can reach high Mean Average Precision (MAP) in some scenarios. PMID:26306236

  20. Kinematics of a Head-Neck Model Simulating Whiplash

    NASA Astrophysics Data System (ADS)

    Colicchia, Giuseppe; Zollman, Dean; Wiesner, Hartmut; Sen, Ahmet Ilhan

    2008-02-01

    A whiplash event is a relative motion between the head and torso that occurs in rear-end automobile collisions. In particular, the large inertia of the head results in a horizontal translation relative to the thorax. This paper describes a simulation of the motion of the head and neck during a rear-end (whiplash) collision. A head-neck model that qualitatively undergoes the same forces acting in whiplash and shows the same behavior is used to analyze the kinematics of both the head and the cervical spine and the resulting neck loads. The rapid acceleration during a whiplash event causes the extension and flexion of the cervical spine, which in turn can cause dislocated vertebrae, torn ligaments, intervertebral disc herniation, and other trauma that appear to be the likely causes of subsequent painful headache or neck pain symptoms. Thus, whiplash provides a connection between the dynamics of the human body and physics. Its treatment can enliven the usual teaching in kinematics, and both theoretical and experimental approaches provide an interesting biological context to teach introductory principles of mechanics.

  1. A semi-automatic method of generating subject-specific pediatric head finite element models for impact dynamic responses to head injury.

    PubMed

    Li, Zhigang; Han, Xiaoqiang; Ge, Hao; Ma, Chunsheng

    2016-07-01

    To account for the effects of head realistic morphological feature variation on the impact dynamic responses to head injury, it is necessary to develop multiple subject-specific pediatric head finite element (FE) models based on computed tomography (CT) or magnetic resonance imaging (MRI) scans. However, traditional manual model development is very time-consuming. In this study, a new automatic method was developed to extract anatomical points from pediatric head CT scans to represent pediatric head morphological features (head size/shape, skull thickness, and suture/fontanel width). Subsequently, a geometry-adaptive mesh morphing method based on radial basis function was developed that can automatically morph a baseline pediatric head FE model into target FE models with geometries corresponding to the extracted head morphological features. In the end, five subject-specific head FE models of approximately 6-month-old (6MO) were automatically generated using the developed method. These validated models were employed to investigate differences in the head dynamic responses among subjects with different head morphologies. The results show that variations in head morphological features have a relatively large effect on pediatric head dynamic response. The results of this study indicate that pediatric head morphological variation had better be taken into account when reconstructing pediatric head injury due to traffic/fall accidents or child abuses using computational models as well as predicting head injury risk for children with obvious difference in head size and morphologies. PMID:27058003

  2. Habitat Suitability Index Models: Yellow-Headed Blackbird

    USGS Publications Warehouse

    Schroeder, Richard L.

    1982-01-01

    Habitat preferences of the yellow-headed blackbird (Xanthocephalus xanthocephalus) are described in this publication. It is one of a series of Habitat Suitability Index (HSI) models and was developed through an analysis of available infomration on the species-habitat requirements of the species. Habitat use information is presented in a review of the literature, followed by the development of an HSI model, designed for use in impact assessment and habitat management activities.

  3. Modeling gas-liquid head performance of electrical submersible pumps

    NASA Astrophysics Data System (ADS)

    Sun, Datong

    The objectives of this study are to develop a simple and accurate theoretical model and to implement the model into a computational tool to predict Electrical Submersible Pumps (ESP) head performance under two-phase flow conditions. A new two-phase model including a set of one-dimensional mass and momentum balance equations was developed. The derived gas-liquid momentum equations along pump channels has improved Sachdeva (1992, 1994)'s model in petroleum industry and generalized Minemura (1998)'s model in nuclear industry. The resulting pressure ODE for frictionless incompressible single-phase flow is consistent with the pump Euler equation. In the two-phase momentum equations, new models for wall frictional losses for each phase, through using gas-liquid stratified assumption and existing correlations for impeller rotating effect, channel curvature effect, and channel cross section effect, have been proposed. New equations for radius of curvature along ESP channels, used in the curvature effect calculation, have been derived. A new shock loss model incorporating rotational speeds has been developed. A new correlation for drag coefficient and interfacial characteristic length effects has been obtained through fitting the model results with experimental data. An algorithm to solve the model equations has been developed and implemented. The model predicts pressure and void fraction distributions along impellers and diffusers and can also be used to predict the pump head performance curve under different fluid properties, pump intake conditions, and rotational speeds. The new two-phase model is validated with air-water experimental data. Results show the model provides a very good prediction for pump head performance under different gas flow rates, liquid flow rates, and different intake pressures. The new model is capable of predicting surging and gas lock conditions.

  4. The kinesin walk: a dynamic model with elastically coupled heads.

    PubMed Central

    Derényi, I; Vicsek, T

    1996-01-01

    Recently individual two-headed kinesin molecules have been studied in in vitro motility assays revealing a number of their peculiar transport properties. In this paper we propose a simple and robust model for the kinesin stepping process with elastically coupled Brownian heads that show all of these properties. The analytic and numerical treatment of our model results in a very good fit to the experimental data and practically has no free parameters. Changing the values of the parameters in the restricted range allowed by the related experimental estimates has almost no effect on the shape of the curves and results mainly in a variation of the zero load velocity that can be directly fitted to the measured data. In addition, the model is consistent with the measured pathway of the kinesin ATPase. PMID:8692894

  5. Bisphophonates related osteonecrosis of the jaw

    PubMed Central

    Gupta, Swati; Gupta, Hemant; Mandhyan, Devendra; Srivastava, Sanjeev

    2013-01-01

    Objective: With sporadic reporting of BPs related osteonecrosis of jaw and in absence of definitive guidelines regarding the management of such patients, the dentists and the oral and maxillofacial surgeons need to be updated about this issue. The objective of this article was to produce an updated bibliographic review of BPs related ONJ. This paper reviews the literature regarding the same for better understanding of the problem and its management. Background: Bisphosphonates (BPs) are potent inhibitors of bone resorption and are widely used in the treatment of osteoporosis and other diseases that cause bone mass loss, such as Paget's disease, bone metastases, and multiple myeloma, to prevent pathological fractures. With increasing use, evidence is emerging that patients taking BP drugs are at risk of developing osteonecrosis of the jaws (ONJs), sometimes occurring spontaneously, but more commonly following dental extractions or oral bone surgery. Materials and Methods: A bibliographic search was carried out using PubMed, Medline, and search engines ending in April, 2013. The search terms used were: Oral BPs, dental implants, and osteonecrosis. Conclusion: On the basis of available literature, the management of patients on bisphosphonates requiring dental treatment is classified according to the duration of BPs treatment, method of administration of BPs etc. Dental treatments when planned carefully in such patients have a fair to good prognosis. PMID:24665168

  6. Mandibular osteonecrosis due to bisphosphonate use

    PubMed Central

    Şalvarcı, Ahmet; Altınay, Serdar

    2015-01-01

    Due to their efficient osteoclastic inhibitor effect in bone metabolism and antiangiogenic activity, bisphosphonates are widely used in many cancer diseases particularly in prostate cancers with bone metastasis, lung cancer, breast cancer and multiple myeloma, as well as in systemic diseases such as osteoporosis, osteopenia, Paget disease and osteogenesis imperfect for the last 13 years. Prostate cancer is a common cancer in males and it is the leading cause of bone metastasis. Mandibular metastasis is rarely encountered during the course of prostate cancer. Mandibular osteonecrosis as well has begun to be observed along with the availability of more efficient and stronger formulations developed following the use of bisphosphonates. Zolendronic acid, which has been used also by our patient, has widely come into practice as a 3rd generation bisphosphonate. Because of prostate cancer and widespread bone metastases, our patient has been receiving zolendronic acid with maximum androgen blockage for 4 years. Tomography of the patient, who has undergone intensive treatment because of submandibular abscess, demonstrated extensive osteonecrosis in the fovea sublingual region of the mandible corpus. In large series, although, mandibular osteonecrosis was widely seen due to bisphosphonate use for the metastases of lung and breast cancers, this rate was between 9.6% and 11% for prostate cancer within the series. Although our patient had no mandibular metastasis before, mandibular necrosis was observed due to long-term bisphosphonate use. We are going to present our patient who had this rare complication with his clinical picture. PMID:26328198

  7. The thermal effects of lavage on 57 ox femoral heads prepared for hip resurfacing arthroplasty

    PubMed Central

    2013-01-01

    Background and purpose Previously, we have documented surface temperatures recorded by thermography great enough to cause osteonecrosis of the femoral head during hip resurfacing. We now performed an in vitro investigation with 3 questions: (1) whether water irrigation reduced bone surface temperature, (2) whether external bone temperatures were similar to core temperatures, and (3) whether blunting of the reamer affected temperature generation. Methods Using an ox-bone model, 57 femoral heads were peripherally reamed. The surface temperatures of bone were measured using a thermal camera and internal bone temperatures were measured using 2 theromocouples. We measured the effects of cooling with water at room temperature and with ice-cooled water. Progressive blunting of reamers was assessed over the 57 experiments. Results Mean and maximum temperatures generated during peripheral reaming were greater when no irrigation was used. Ice-cold saline protected femoral heads from thermal damage. External bone temperatures were much greater than internal temperatures, which were not sufficiently elevated to cause osteonecrosis regardless of lavage. Blunting of the reamer was not found to have a statistically significant effect in this study. Interpretation Cooling with ice-cooled water is recommended. Internal bone temperatures are not elevated despite the high surface temperatures reached during femoral head resurfacing. PMID:24079554

  8. Development of a Finite Element Head Model for the Study of Impact Head Injury

    PubMed Central

    Yang, Bin; Tse, Kwong-Ming; Chen, Ning; Tan, Long-Bin; Zheng, Qing-Qian; Yang, Hui-Min; Hu, Min; Pan, Gang; Lee, Heow-Pueh

    2014-01-01

    This study is aimed at developing a high quality, validated finite element (FE) human head model for traumatic brain injuries (TBI) prediction and prevention during vehicle collisions. The geometry of the FE model was based on computed tomography (CT) and magnetic resonance imaging (MRI) scans of a volunteer close to the anthropometry of a 50th percentile male. The material and structural properties were selected based on a synthesis of current knowledge of the constitutive models for each tissue. The cerebrospinal fluid (CSF) was simulated explicitly as a hydrostatic fluid by using a surface-based fluid modeling method. The model was validated in the loading condition observed in frontal impact vehicle collision. These validations include the intracranial pressure (ICP), brain motion, impact force and intracranial acceleration response, maximum von Mises stress in the brain, and maximum principal stress in the skull. Overall results obtained in the validation indicated improved biofidelity relative to previous FE models, and the change in the maximum von Mises in the brain is mainly caused by the improvement of the CSF simulation. The model may be used for improving the current injury criteria of the brain and anthropometric test devices. PMID:25405201

  9. Adalimumab: Another Medication Related to Osteonecrosis of the Jaws?

    PubMed

    Cassoni, Andrea; Romeo, Umberto; Terenzi, Valentina; Della Monaca, Marco; Rajabtork Zadeh, Oriana; Raponi, Ingrid; Fadda, Maria Teresa; Polimeni, Antonella; Valentini, Valentino

    2016-01-01

    Objective. The acronym MRONJ has been created in order to identify "Medication-Related Osteonecrosis of the Jaw," observed after the use of Bisphosphonates, RANK ligand inhibitor, and antiangiogenic medications. Only a case of osteonecrosis of the jaw in a Chron's disease patient following a course of Bisphosphonate and Adalimumab therapy has been recently described, so that it has been supposed that also this medication could promote manifestation of osteonecrosis. Clinical Case. On August, 2014, a 63-year-old female with a history of idiopathic arthritis treated with medical treatment with Adalimumab from 2010 to 2013 presented referring pain in the right mandible. Results. This patient presented with nonexposed osteonecrosis of the jaw after placement, on September, 2010, of four titanium fixtures in the mandible. Conclusions. The authors suggest that the biologic therapy with an anti-TNF-α antibody might promote the manifestation of osteonecrosis and compromise oral healing capacity of the bone. PMID:27088019

  10. Adalimumab: Another Medication Related to Osteonecrosis of the Jaws?

    PubMed Central

    Cassoni, Andrea; Romeo, Umberto; Terenzi, Valentina; Della Monaca, Marco; Rajabtork Zadeh, Oriana; Raponi, Ingrid; Fadda, Maria Teresa; Polimeni, Antonella; Valentini, Valentino

    2016-01-01

    Objective. The acronym MRONJ has been created in order to identify “Medication-Related Osteonecrosis of the Jaw,” observed after the use of Bisphosphonates, RANK ligand inhibitor, and antiangiogenic medications. Only a case of osteonecrosis of the jaw in a Chron's disease patient following a course of Bisphosphonate and Adalimumab therapy has been recently described, so that it has been supposed that also this medication could promote manifestation of osteonecrosis. Clinical Case. On August, 2014, a 63-year-old female with a history of idiopathic arthritis treated with medical treatment with Adalimumab from 2010 to 2013 presented referring pain in the right mandible. Results. This patient presented with nonexposed osteonecrosis of the jaw after placement, on September, 2010, of four titanium fixtures in the mandible. Conclusions. The authors suggest that the biologic therapy with an anti-TNF-α antibody might promote the manifestation of osteonecrosis and compromise oral healing capacity of the bone. PMID:27088019

  11. Bisphosphonate-Related Osteonecrosis of the Jaw: Specificities

    PubMed Central

    Paulo, Siri; Abrantes, Ana Margarida; Laranjo, Mafalda; Carvalho, Lina; Serra, Arménio; Botelho, Maria Filomena; Ferreira, Manuel Marques

    2014-01-01

    Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe complication that has recently emerged in patients treated with intravenous bisphosphonates for malignant diseases. This complication usually presents after a minor local trauma during a dental treatment. Several etiopathogenic mechanisms of this pathological condition have been proposed, but no model can explain all morphological changes observed at the macroscopic and microscopic level. BRONJ is likely to be related to direct toxicity in the bone and soft tissue cells, due to nitrogen-containing bisphosphonates. This review elucidates the clinical indications and mechanism of action of bisphosphonates, reports some clinical diagnostic criteria for BRONJ, describe the histopathological criteria for BRONJ diagnosis, the potential triggering pathways and the available treatment strategies. PMID:25992241

  12. Human head-neck computational model for assessing blast injury.

    PubMed

    Roberts, J C; Harrigan, T P; Ward, E E; Taylor, T M; Annett, M S; Merkle, A C

    2012-11-15

    A human head finite element model (HHFEM) was developed to study the effects of a blast to the head. To study both the kinetic and kinematic effects of a blast wave, the HHFEM was attached to a finite element model of a Hybrid III ATD neck. A physical human head surrogate model (HSHM) was developed from solid model files of the HHFEM, which was then attached to a physical Hybrid III ATD neck and exposed to shock tube overpressures. This allowed direct comparison between the HSHM and HHFEM. To develop the temporal and spatial pressures on the HHFEM that would simulate loading to the HSHM, a computational fluid dynamics (CFD) model of the HHFEM in front of a shock tube was generated. CFD simulations were made using loads equivalent to those seen in experimental studies of the HSHM for shock tube driver pressures of 517, 690 and 862 kPa. Using the selected brain material properties, the peak intracranial pressures, temporal and spatial histories of relative brain-skull displacements and the peak relative brain-skull displacements in the brain of the HHFEM compared favorably with results from the HSHM. The HSHM sensors measured the rotations of local areas of the brain as well as displacements, and the rotations of the sensors in the sagittal plane of the HSHM were, in general, correctly predicted from the HHFEM. Peak intracranial pressures were between 70 and 120 kPa, while the peak relative brain-skull displacements were between 0.5 and 3.0mm. PMID:23010219

  13. Development of skull fracture criterion based on real-world head trauma simulations using finite element head model.

    PubMed

    Sahoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy

    2016-04-01

    The objective of this study was to enhance an existing finite element (FE) head model with composite modeling and a new constitutive law for the skull. The response of the state-of-the-art FE head model was validated in the time domain using data from 15 temporo-parietal impact experiments, conducted with postmortem human surrogates. The new model predicted skull fractures observed in these tests. Further, 70 well-documented head trauma cases were reconstructed. The 15 experiments and 70 real-world head trauma cases were combined to derive skull fracture injury risk curves. The skull internal energy was found to be the best candidate to predict skull failure based on an in depth statistical analysis of different mechanical parameters (force, skull internal energy), head kinematic-based parameter, the head injury criterion (HIC), and skull fracture correlate (SFC). The proposed tolerance limit for 50% risk of skull fracture was associated with 453mJ of internal energy. Statistical analyses were extended for individual impact locations (frontal, occipital and temporo-parietal) and separate injury risk curves were obtained. The 50% risk of skull fracture for each location: frontal: 481mJ, occipital: 457mJ, temporo-parietal: 456mJ of skull internal energy. PMID:26703363

  14. Periapical Disease and Bisphosphonates Induce Osteonecrosis of the Jaws in Mice

    PubMed Central

    Kang, Ben; Cheong, Simon; Chaichanasakul, Thawinee; Bezouglaia, Olga; Atti, Elisa; Dry, Sarah M; Pirih, Flavia Q; Aghaloo, Tara L.; Tetradis, Sotirios

    2013-01-01

    Osteonecrosis of the jaw (ONJ) is a well-recognized complication of antiresorptive medications, such as bisphosphonates (BPs). Although ONJ is most common after tooth extractions in patients receiving high dose BPs, many patients do not experience oral trauma. Animal models utilizing tooth extractions and high BP doses recapitulate several clinical, radiographic and histologic findings of ONJ. We and others have reported on rat models of ONJ utilizing experimental dental disease in the absence of tooth extraction. These models emphasize the importance of dental infection/inflammation for ONJ development. Here, we extend our original report in the rat, and present a mouse model of ONJ in the presence of dental disease. Mice were injected with high dose zoledronic acid and pulpal exposure of mandibular molars was performed to induce periapical disease. After 8 weeks, quantitative and qualitative radiographic and histologic analyses of mouse mandibles were executed. Periapical lesions were larger in vehicle- vs. BP treated mice. Importantly, radiographic features resembling clinical ONJ, including thickening of the lamina dura, periosteal bone deposition and increased trabecular density, were seen in the drilled site of BP treated animals. Histologically, osteonecrosis, periosteal thickening, periosteal bone apposition, epithelial migration and bone exposure were present in the BP treated animals in the presence of periapical disease. No difference in TRAP+ cell numbers was observed, but round, detached, and removed from the bone surface cells were present in BP animals. Although 88% of the BP animals showed areas of osteonecrosis in the dental disease site, only 33% developed bone exposure, suggesting that osteonecrosis precedes bone exposure. Our data further emphasize the importance of dental disease in ONJ development, provide qualitative and quantitative measures of ONJ, and present a novel mouse ONJ model in the absence of tooth extraction that should be useful

  15. Osteonecrosis of the Jaw Developed in Mice

    PubMed Central

    Park, Sil; Kanayama, Keiichi; Kaur, Kawaljit; Tseng, Han-Ching Helen; Banankhah, Sina; Quje, Davood Talebi; Sayre, James W.; Jewett, Anahid; Nishimura, Ichiro

    2015-01-01

    Osteonecrosis of the jaw (ONJ), an uncommon co-morbidity in patients treated with bisphosphonates (BP), occurs in the segment of jawbone interfacing oral mucosa. This study aimed to investigate a role of oral mucosal barrier γδ T cells in the pathogenesis of ONJ. Female C57Bl/6J (B6) mice received a bolus zoledronate intravenous injection (ZOL, 540 μg/kg), and their maxillary left first molars were extracted 1 week later. ZOL-treated mice (WT ZOL) delayed oral wound healing with patent open wounds 4 weeks after tooth extraction with characteristic oral epithelial hyperplasia. γδ T cells appeared within the tooth extraction site and hyperplastic epithelium in WT ZOL mice. In ZOL-treated γδ T cell null (Tcrd−/− ZOL) mice, the tooth extraction open wound progressively closed; however, histological ONJ-like lesions were identified in 75 and 60% of WT ZOL and Tcrd−/− ZOL mice, respectively. Although the bone exposure phenotype of ONJ was predominantly observed in WT ZOL mice, Tcrd−/− ZOL mice developed the pustule/fistula disease phenotype. We further addressed the role of γδ T cells from human peripheral blood (h-γδ T cells). When co-cultured with ZOL-pretreated human osteoclasts in vitro, h-γδ T cells exhibited rapid expansion and robust IFN-γ secretion. When h-γδ T cells were injected into ZOL-treated immunodeficient (Rag2−/− ZOL) mice, the oral epithelial hyperplasia developed. However, Rag2−/− ZOL mice did not develop osteonecrosis. The results indicate that γδ T cells are unlikely to influence the core osteonecrosis mechanism; however, they may serve as a critical modifier contributing to the different oral mucosal disease variations of ONJ. PMID:26013832

  16. Treatment of Osteonecrosis of the Jaw.

    PubMed

    Yamachika, Eiki; Matsubara, Masakazu; Ikeda, Atsushi; Matsumura, Tatsushi; Moritani, Norifumi; Iida, Seiji

    2015-10-01

    The definition of bisphosphonate-related osteonecrosis of the jaw (BRONJ) was recently broadened and it is now known as medication-related osteonecrosis of the jaw (MRONJ). To date, the management of MRONJ is controversial. Conservative treatment is recommended, but it is difficult to successfully treat stage 3 MRONJ. Administration of teriparatide for the MRONJ treatment has only been documented in independent case reports and there are few reports on men with MRONJ treated with teriparatide. An 81-year-old man was referred in May 2014 for treatment of an unhealed tooth extraction wound in the mandible. He took minodronic acid hydrate (1 mg/d orally) for 2 years because of osteoporosis cure. On clinical examination, soft tissue swelling in the left mandibular first molar region extended to the inferior border of the mandible with extraoral fistula. Computed tomography (CT) revealed osteolysis extending to the inferior border resulting in pathologic fracture of mandibular bone. Based on these findings, a diagnosis of stage 3 MRONJ was made. We performed conservative treatment, including amoxicillin, but his symptoms did not improve. He was then treated with once-weekly subcutaneous injection of teriparatide. Although teriparatide injections were started without antibiotics, after 1 week, swelling, erythema, and purulent discharge from the extraoral fistula increased rapidly. Therefore, we combined the once-weekly teriparatide injection with amoxicillin administration. Three months later, the osteonecrosis had healed and CT showed significant bone regeneration and healing of the mandibular pathologic fracture. In addition, the mandibular fistula showed healing and the intraoral fistula was covered with normal mucosa. PMID:26468825

  17. Intraosseous hypertension and venous congestion in osteonecrosis of the knee.

    PubMed

    Uchio, Y; Ochi, M; Adachi, N; Nishikori, T; Kawasaki, K

    2001-03-01

    To determine whether an angiogenic factor affects the pathogenesis of the idiopathic osteonecrosis of the medial femoral condyle, intraosseous pressure and venogram in 11 knees with osteonecrosis were compared with intraosseous pressure and venogram in 11 knees with the medial type of osteoarthritis. Patients were matched by age, gender, obesity index, blood pressure, tibiofemoral angle, and clinical evaluation. The intraosseous pressure of the medial condyle of the knees with osteonecrosis (62.8 +/- 27.3 mm Hg) was significantly higher than that in the lateral condyle of the knees with osteonecrosis (25.4 +/- 18.9 mm Hg) and those of both condyles of the knees with osteoarthritis (medial, 31.6 +/- 17.4 mm Hg; lateral, 29.5 +/- 11.0 mm Hg). In contrast, there was no significant difference in the pressure between the medial and lateral condyles of the knees with osteoarthritis. Venography showed a marked disturbance of venous drainage in all patients with osteonecrosis. In addition, the average clearance time of the medium in the medial femoral condyle was significantly more prolonged in patients with osteonecrosis (17.7 +/- 6.1 minutes) than in patients with osteoarthritis (5.5 +/- 1.6 minutes). These data support the hypothesis that venous stasis within the medullar canal in the condyle increases intraosseous pressure and decreases arteriovenous pressure difference, leading to osteonecrosis. PMID:11249168

  18. 3D head model classification using optimized EGI

    NASA Astrophysics Data System (ADS)

    Tong, Xin; Wong, Hau-san; Ma, Bo

    2006-02-01

    With the general availability of 3D digitizers and scanners, 3D graphical models have been used widely in a variety of applications. This has led to the development of search engines for 3D models. Especially, 3D head model classification and retrieval have received more and more attention in view of their many potential applications in criminal identifications, computer animation, movie industry and medical industry. This paper addresses the 3D head model classification problem using 2D subspace analysis methods such as 2D principal component analysis (2D PCA[3]) and 2D fisher discriminant analysis (2DLDA[5]). It takes advantage of the fact that the histogram is a 2D image, and we can extract the most useful information from these 2D images to get a good result accordingingly. As a result, there are two main advantages: First, we can perform less calculation to obtain the same rate of classification; second, we can reduce the dimensionality more than PCA to obtain a higher efficiency.

  19. Enoxaparin Prevents Steroid-Related Avascular Necrosis of the Femoral Head

    PubMed Central

    Beckmann, Rainer; Shaheen, Hayfaa; Kweider, Nisreen; Ghassemi, Alireza; Fragoulis, Athanassios; Hermanns-Sachweh, Benita; Pufe, Thomas; Kadyrov, Mamed; Drescher, Wolf

    2014-01-01

    Nontraumatic osteonecrosis of the femoral head is still a challenging problem in orthopedic surgery. It is responsible for 10% of the 500,000 hip replacement surgeries in the USA and affects relatively young, active patients in particular. Main reasons for nontraumatic osteonecrosis are glucocorticoid use, alcoholism, thrombophilia, and hypofibrinolysis (Glueck et al., 1997; Orth and Anagnostakos, 2013). One pathomechanism of steroid-induced osteonecrosis is thought to be impaired blood flow to the femoral head caused by increased thrombus formation and vasoconstriction. To investigate the preventive effect of enoxaparin on steroid-related osteonecrosis, we used male New Zealand white rabbits. Osteonecrosis was induced by methylprednisolone-injection (1 × 20 mg/kg body weight). Control animals were treated with phosphate-buffered saline. Treatment consisted of an injection of 11.7 mg/kg body weight of enoxaparin per day (Clexane) in addition to methylprednisolone. Four weeks after methylprednisolone-injection the animals were sacrificed. Histology (hematoxylin-eosin and Ladewig staining) was performed, and empty lacunae and histological signs of osteonecrosis were quantified. Histomorphometry revealed a significant increase in empty lacunae and necrotic changed osteocytes in glucocorticoid-treated animals as compared with the glucocorticoid- and Clexane-treated animals and with the control group. No significant difference was detected between the glucocorticoid and Clexane group and the control group. This finding suggests that cotreatment with enoxaparin has the potential to prevent steroid-associated osteonecrosis. PMID:25110730

  20. Animal models of head and neck squamous cell carcinoma.

    PubMed

    Supsavhad, Wachiraphan; Dirksen, Wessel P; Martin, Chelsea K; Rosol, Thomas J

    2016-04-01

    Head and neck squamous cell carcinoma (HNSCC) is the most common oral cancer worldwide. Local bone invasion into the maxilla or mandible and metastasis to regional lymph nodes often result in a poor prognosis, decreased quality of life and shortened survival time for HNSCC patients. Poor response to treatment and clinical outcomes are the major concerns in this aggressive cancer. Multiple animal models have been developed to replicate spontaneous HNSCC and investigate genetic alterations and novel therapeutic targets. This review provides an overview of HNSCC as well as the traditional animal models used in HNSCC preclinical research. The value and challenges of each in vivo model are discussed. Similarity between HNSCC in humans and cats and the possibility of using spontaneous feline oral squamous cell carcinoma (FOSCC) as a model for HNSCC in translational research are highlighted. PMID:26965084

  1. Improved transcranial magnetic stimulation coil design with realistic head modeling

    NASA Astrophysics Data System (ADS)

    Crowther, Lawrence; Hadimani, Ravi; Jiles, David

    2013-03-01

    We are investigating Transcranial magnetic stimulation (TMS) as a noninvasive technique based on electromagnetic induction which causes stimulation of the neurons in the brain. TMS can be used as a pain-free alternative to conventional electroconvulsive therapy (ECT) which is still widely implemented for treatment of major depression. Development of improved TMS coils capable of stimulating subcortical regions could also allow TMS to replace invasive deep brain stimulation (DBS) which requires surgical implantation of electrodes in the brain. Our new designs allow new applications of the technique to be established for a variety of diagnostic and therapeutic applications of psychiatric disorders and neurological diseases. Calculation of the fields generated inside the head is vital for the use of this method for treatment. In prior work we have implemented a realistic head model, incorporating inhomogeneous tissue structures and electrical conductivities, allowing the site of neuronal activation to be accurately calculated. We will show how we utilize this model in the development of novel TMS coil designs to improve the depth of penetration and localization of stimulation produced by stimulator coils.

  2. A conceptual model of emergency physician decision making for head computed tomography in mild head injury.

    PubMed

    Probst, Marc A; Kanzaria, Hemal K; Schriger, David L

    2014-06-01

    The use of computed tomographic scanning in blunt head trauma has increased dramatically in recent years without an accompanying rise in the prevalence of injury or hospital admission for serious conditions. Because computed tomography is neither harmless nor inexpensive, researchers have attempted to optimize utilization, largely through research that describes which clinical variables predict intracranial injury, and use this information to develop clinical decision instruments. Although such techniques may be useful when the benefits and harms of each strategy (neuroimaging vs observation) are quantifiable and amenable to comparison, the exact magnitude of these benefits and harms remains unknown in this clinical scenario. We believe that most clinical decision instrument development efforts are misguided insofar as they ignore critical, nonclinical factors influencing the decision to image. In this article, we propose a conceptual model to illustrate how clinical and nonclinical factors influence emergency physicians making this decision. We posit that elements unrelated to standard clinical factors, such as personality of the physician, fear of litigation and of missed diagnoses, patient expectations, and compensation method, may have equal or greater impact on actual decision making than traditional clinical factors. We believe that 3 particular factors deserve special consideration for further research: fear of error/malpractice, financial incentives, and patient engagement. Acknowledgement and study of these factors will be essential if we are to understand how emergency physicians truly make these decisions and how test-ordering behavior can be modified. PMID:24560384

  3. [Conditionally pathogenic microorganisms in patients with bisphosphonate jaw osteonecrosis].

    PubMed

    Ivanyushko, T P; Polyakov, K A; Medvedev, Yu A; Shamanaev, S V; Trofimov, D Yu; Abramov, D D; Balyikin, R A

    2016-01-01

    The objective of the study was to define treatment strategy in cases of facial bones bisphosphonate induced osteonecrosis based on the study of the role of conditionally pathogenic oral microorganisms. Three typical clinical cases of bisphosphonate osteonecrosis of the facial bones were analyzed and 15 conditionally pathogenic oral microorganisms were identified in these patients using real-time PCR in saliva, wound and bone samples. A comparative analysis was carried out with purulent-inflammatory diseases of maxillofacial area. The study results proved an important role of conditionally pathogenic microorganisms of the oral cavity in the development of osteonecrosis of the facial bones. Wide range of bacterial species was identified in osteonecrosis of the facial bones patients. While bone tissue is most exposed to microbial communities, surgical treatment results in effective rehabilitation for a long period. PMID:26925566

  4. BISPHOSPHONATE-INDUCED MAXILLOFACIAL OSTEONECROSIS IN OSTEOPOROTIC INDIVIDUALS

    PubMed Central

    da Silva Santos, Paulo Sérgio; Oliveira, Márcio Augusto; Felix, Valtuir Barbosa

    2015-01-01

    Bisphosphonate-related osteonecrosis of the maxillae may be an important complication of long-term osteoporosis treatment. The possibility of osteonecrosis of the maxillae in patients exposed to nitrogenated bisphosphonates was first described in 2003. Since then, case reports and retrospective studies have demonstrated higher percentages of occurrence of osteonecrosis in patients who have used or are using bisphosphonates. Although this complication may be spontaneous, invasive oral procedures have a role as risk factors associated with dental procedures such as tooth extractions and other bone operations. In addition, tooth infections and periodontal disease have been reported to be the main risk factors for development of bisphosphonate-induced osteonecrosis of the maxillae. For this reason, dentists, general clinicians, orthopedists, geriatricians and oral-maxillofacial surgeons need to be aware of this problem and work in a multidisciplinary environment, thereby stimulating early diagnosis and prevention of further potential cases. PMID:27027044

  5. Modeling head and neck cancer stem cell-mediated tumorigenesis.

    PubMed

    Pearson, Alexander T; Jackson, Trachette L; Nör, Jacques E

    2016-09-01

    A large body of literature has emerged supporting the importance of cancer stem cells (CSCs) in the pathogenesis of head and neck cancers. CSCs are a subpopulation of cells within a tumor that share the properties of self-renewal and multipotency with stem cells from normal tissue. Their functional relevance to the pathobiology of cancer arises from the unique properties of tumorigenicity, chemotherapy resistance, and their ability to metastasize and invade distant tissues. Several molecular profiles have been used to discriminate a stem cell from a non-stem cell. CSCs can be grown for study and further enriched using a number of in vitro techniques. An evolving option for translational research is the use of mathematical and computational models to describe the role of CSCs in complex tumor environments. This review is focused discussing the evidence emerging from modeling approaches that have clarified the impact of CSCs to the biology of cancer. PMID:27151511

  6. Testosterone Therapy Can Interact With Thrombophilia, Leading to Osteonecrosis.

    PubMed

    Glueck, Charles J; Riaz, Rashid; Prince, Marloe; Freiberg, Richard A; Wang, Ping

    2015-12-01

    Although this effect is not widely recognized, testosterone therapy can interact with thrombophilia, causing osteonecrosis. In 12 men and 4 women who had idiopathic osteonecrosis a median of 6 months after the onset of testosterone therapy, the authors examined the interaction between testosterone therapy and previously undiagnosed thrombophilia. The authors hypothesized that patients who had osteonecrosis after starting testosterone therapy were more likely than 110 normal control subjects or 48 patients who had osteonecrosis and were not receiving testosterone therapy to have thrombophilia. Measures of thrombophilia included Factor V Leiden, prothrombin, PAI-1 gene mutations, Factor VIII, Factor XI, anticardiolipin antibody immunoglobulin G or immunoglobulin M, and homocysteine values. In 10 cases, osteonecrosis occurred 6 months or less after the onset of testosterone therapy, and in all 16 cases, it occurred after a median of 6 months of testosterone therapy. Of the 16 cases, 5 (31%) were Factor V Leiden heterozygotes vs 2 of 109 (2%) healthy control subjects (P=.0003) and 4 of 48 patients who had osteonecrosis and were not receiving testosterone therapy (P=.04). Of the 16 cases, 4 (25%) had high (>150%) Factor VIII levels vs 7 of 103 (7%) healthy control subjects (P=.04), and 3 (19%) had high (>150%) Factor XI levels vs 3 of 101 (3%) healthy control subjects (P=.03). Of the 16 patients with osteonecrosis, 14 (88%) had at least 1 abnormal procoagulant value (of the 8 measured) vs 47 of 110 (43%) healthy control subjects (P=.0009). Of the 5 men whose serum estradiol level was measured while they were receiving testosterone therapy, this level was high (≥42.6 pg/mL) in 4. When testosterone therapy is given to patients with thrombophilia, they are at increased risk for osteonecrosis. PMID:26652327

  7. Combined with Bone Marrow-Derived Cells and rhBMP-2 for Osteonecrosis after Femoral Neck Fractures in Children and Adolescents: A case series

    PubMed Central

    Gao, Fuqiang; Sun, Wei; Guo, Wanshou; Wang, Bailiang; Cheng, Liming; Li, Zirong

    2016-01-01

    Osteonecrosis of the femoral head (ONFH) following femoral neck fractures is a rare, yet severe, disorder in children and adolescents. This study evaluated the effectiveness of core decompression (CD) combined with implantation of bone marrow–derived cells (BMDC) and rhBMP-2 for osteonecrosis of femoral head (ONFH) after femoral neck fractures in children and adolescents. This study included 51 patients, aged 11.4–18.1 years, with ARCO stages I–III ONFH after femoral neck fractures between 2004 and 2010. The hips were divided into two groups based on whether the lateral pillar of the femoral head (LPFH) was preserved: LPFH and non-LPFH groups. All patients were followed up clinically and radiographically for a minimum of 5 years. 44 patients (86.3%) had improved clinical outcome. Radiologically, 9 of the 51 hips (17.6%) exhibited collapse onset or progression of the femoral head or narrowing of the hip joint space, and one patient in the non-LPFH group required hip arthroplasty due to the worsened syndrome. The technique provided an effective therapeutic option for children and adolescents with ONFH following femoral neck fractures. It relieves hip pain and prevents the progression of osteonecrosis in young patients lasting more than 5 years after surgery. PMID:27477836

  8. Combined with Bone Marrow-Derived Cells and rhBMP-2 for Osteonecrosis after Femoral Neck Fractures in Children and Adolescents: A case series.

    PubMed

    Gao, Fuqiang; Sun, Wei; Guo, Wanshou; Wang, Bailiang; Cheng, Liming; Li, Zirong

    2016-01-01

    Osteonecrosis of the femoral head (ONFH) following femoral neck fractures is a rare, yet severe, disorder in children and adolescents. This study evaluated the effectiveness of core decompression (CD) combined with implantation of bone marrow-derived cells (BMDC) and rhBMP-2 for osteonecrosis of femoral head (ONFH) after femoral neck fractures in children and adolescents. This study included 51 patients, aged 11.4-18.1 years, with ARCO stages I-III ONFH after femoral neck fractures between 2004 and 2010. The hips were divided into two groups based on whether the lateral pillar of the femoral head (LPFH) was preserved: LPFH and non-LPFH groups. All patients were followed up clinically and radiographically for a minimum of 5 years. 44 patients (86.3%) had improved clinical outcome. Radiologically, 9 of the 51 hips (17.6%) exhibited collapse onset or progression of the femoral head or narrowing of the hip joint space, and one patient in the non-LPFH group required hip arthroplasty due to the worsened syndrome. The technique provided an effective therapeutic option for children and adolescents with ONFH following femoral neck fractures. It relieves hip pain and prevents the progression of osteonecrosis in young patients lasting more than 5 years after surgery. PMID:27477836

  9. Low resolution brain electromagnetic tomography in a realistic geometry head model: a simulation study

    NASA Astrophysics Data System (ADS)

    Ding, Lei; Lai, Yuan; He, Bin

    2005-01-01

    It is of importance to localize neural sources from scalp recorded EEG. Low resolution brain electromagnetic tomography (LORETA) has received considerable attention for localizing brain electrical sources. However, most such efforts have used spherical head models in representing the head volume conductor. Investigation of the performance of LORETA in a realistic geometry head model, as compared with the spherical model, will provide useful information guiding interpretation of data obtained by using the spherical head model. The performance of LORETA was evaluated by means of computer simulations. The boundary element method was used to solve the forward problem. A three-shell realistic geometry (RG) head model was constructed from MRI scans of a human subject. Dipole source configurations of a single dipole located at different regions of the brain with varying depth were used to assess the performance of LORETA in different regions of the brain. A three-sphere head model was also used to approximate the RG head model, and similar simulations performed, and results compared with the RG-LORETA with reference to the locations of the simulated sources. Multi-source localizations were discussed and examples given in the RG head model. Localization errors employing the spherical LORETA, with reference to the source locations within the realistic geometry head, were about 20-30 mm, for four brain regions evaluated: frontal, parietal, temporal and occipital regions. Localization errors employing the RG head model were about 10 mm over the same four brain regions. The present simulation results suggest that the use of the RG head model reduces the localization error of LORETA, and that the RG head model based LORETA is desirable if high localization accuracy is needed.

  10. The potential and limitations of utilising head impact injury models to assess the likelihood of significant head injury in infants after a fall.

    PubMed

    Cory, C Z; Jones, M D; James, D S; Leadbeatter, S; Nokes, L D

    2001-12-01

    The use of engineering principles in assessing head injury scenarios is of increasing significance in investigations into suspected child abuse. A fall scenario is often given as the history for a head injury to an infant. This paper addresses the basic engineering principles and factors to be considered when calculating the severity of a head impact after free-fall. The application of head injury models (HIMs) to ascertain the forces involved in childhood head injuries from impact is also discussed. Previous studies including Duhaime et al. [J. Neurosurg. 66 (1987) 409] and Nokes et al. [Forensic Sci. Int. 79 (1995) 85] have utilised HIMs for this purpose: this paper reviews those models most widely documented.The HIM currently considered the 'state-of-the-art' is the head injury criterion (HIC) and it is suggested that this model should be utilised for assessing head impact injury in child abuse cases where appropriate. PMID:11728733

  11. A Cardiovascular Mathematical Model of Graded Head-Up Tilt

    PubMed Central

    Lim, Einly; Chan, Gregory S. H.; Dokos, Socrates; Ng, Siew C.; Latif, Lydia A.; Vandenberghe, Stijn; Karunanithi, Mohan; Lovell, Nigel H.

    2013-01-01

    A lumped parameter model of the cardiovascular system has been developed and optimized using experimental data obtained from 13 healthy subjects during graded head-up tilt (HUT) from the supine position to . The model includes descriptions of the left and right heart, direct ventricular interaction through the septum and pericardium, the systemic and pulmonary circulations, nonlinear pressure volume relationship of the lower body compartment, arterial and cardiopulmonary baroreceptors, as well as autoregulatory mechanisms. A number of important features, including the separate effects of arterial and cardiopulmonary baroreflexes, and autoregulation in the lower body, as well as diastolic ventricular interaction through the pericardium have been included and tested for their significance. Furthermore, the individual effect of parameter associated with heart failure, including LV and RV contractility, baseline systemic vascular resistance, pulmonary vascular resistance, total blood volume, LV diastolic stiffness and reflex gain on HUT response have also been investigated. Our fitted model compares favorably with our experimental measurements and published literature at a range of tilt angles, in terms of both global and regional hemodynamic variables. Compared to the normal condition, a simulated congestive heart failure condition produced a blunted response to HUT with regards to the percentage changes in cardiac output, stroke volume, end diastolic volume and effector response (i.e., heart contractility, venous unstressed volume, systemic vascular resistance and heart rate) with progressive tilting. PMID:24204817

  12. Osteonecrosis in patients with malignant lymphoma. A review of 31 cases

    SciTech Connect

    Rossleigh, M.A.; Smith, J.; Straus, D.J.; Engel, I.A.

    1986-09-01

    Osteonecrosis of the femoral and humeral heads is a serious complication of therapy for Hodgkin's disease and non-Hodgkin's lymphoma. Twenty-five patients were reassessed 5 years after being initially reported, in order to study the further progress and natural history of this complication. In addition, six recent patients who have also developed this condition are presented. With 5-year additional follow-up, no patient had developed symptoms of osteonecrosis in any bone other than those initially involved. Five patients developed severe complications thought to arise from their therapy suggesting that this group of patients were more sensitive to radiation injury than other patients treated with this modality. During the relatively short follow-up 5-year period, a surprising finding was the fact that 31% of the patients with Hodgkin's disease and 50% with non-Hodgkin's lymphoma had died. It is recommended that patients treated for lymphoma with steroid containing chemotherapy and radiotherapy be observed carefully for the occurrence of joint pain. Early diagnosis should lead to attempts to prevent total joint destruction.

  13. Mandibular osteonecrosis and Ramsay Hunt syndrome following a case of herpes zoster.

    PubMed

    Rudd, Travis; Chai, Bryan Y; Gurunluoglu, Raffi; Glasgow, Mark

    2014-10-01

    Varicella zoster virus (VZV) is the agent that causes chicken pox, a common childhood infection that characteristically presents as vesicular rashes affecting the trunk and head. After the primary infection has resolved, VZV lies dormant in the spinal dorsal root ganglia or extramedullary cranial nerve ganglia until reactivation results in herpes zoster (shingles). The sensory nerves of the trunk, as in classic shingles, and the fifth cranial nerve, as in trigeminal zoster, are the most frequently affected. Shingles is an acute viral infection characterized by the appearance of painful unilateral vesicular rash usually restricted to a dermatomal distribution of a sensory nerve. The rash of shingles is usually preceded by pain and paresthesia. A rare, severe complication of the reactivation of VZV in the geniculate ganglion of the facial nerve is Ramsay Hunt syndrome (RHS). RHS is characterized by otalgia, vesicles in the auditory canal, and ipsilateral facial paralysis. An even rarer complication of VZV infection includes post-zoster osteonecrosis. This report documents a case of severe mandibular osteonecrosis and RHS after an outbreak of herpes zoster and treatment strategies. PMID:25234535

  14. Surgical treatment of jaw osteonecrosis in "Krokodil" drug addicted patients.

    PubMed

    Poghosyan, Yuri M; Hakobyan, Koryun A; Poghosyan, Anna Yu; Avetisyan, Eduard K

    2014-12-01

    Retrospective study of jaw osteonecrosis treatment in patients using the "Krokodil" drug from 2009 to 2013. On the territory of the former USSR countries there is widespread use of a self-produced drug called "Krokodil". Codeine containing analgesics ("Sedalgin", "Pentalgin" etc), red phosphorus (from match boxes) and other easily acquired chemical components are used for synthesis of this drug, which used intravenously. Jaw osteonecrosis develops as a complication in patients who use "Krokodil". The main feature of this disease is jawbone exposure in the oral cavity. Surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". 40 "Krokodil" drug addict patients with jaw osteonecrosis were treated. Involvement of maxilla was found in 11 patients (27.5%), mandible in 21 (52.5%), both jaws in 8 (20%) patients. 35 Lesions were found in 29 mandibles and 21 lesions in 19 maxillas. Main factors of treatment success are: cessation of "Krokodil" use in the pre- (minimum 1 month) and postoperative period and osteonecrosis area resection of a minimum of 0.5 cm beyond the visible borders of osteonecrosis towards the healthy tissues. Surgery was not delayed until sequestrum formation. In the mandible marginal or segmental resection (with or without TMJ exarticulation) was performed. After surgery recurrence of disease was seen in 8 (23%) cases in the mandible, with no cases of recurrence in the maxilla. According to our experience in this case series, surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". Cessation of drug use and jaw resection minimize the rate of recurrences in such patients. PMID:24969764

  15. Characterizing Discourse Deficits Following Penetrating Head Injury: A Preliminary Model

    ERIC Educational Resources Information Center

    Coelho, Carl; Le, Karen; Mozeiko, Jennifer; Hamilton, Mark; Tyler, Elizabeth; Krueger, Frank; Grafman, Jordan

    2013-01-01

    Purpose: Discourse analyses have demonstrated utility for delineating subtle communication deficits following closed head injuries (CHIs). The present investigation examined the discourse performance of a large group of individuals with penetrating head injury (PHI). Performance was also compared across 6 subgroups of PHI based on lesion locale. A…

  16. Analysis of finite element models for head injury investigation: reconstruction of four real-world impacts.

    PubMed

    Franklyn, Melanie; Fildes, Brian; Zhang, Liying; Yang, King; Sparke, Laurie

    2005-11-01

    Previous studies have shown that both excessive linear and rotational accelerations are the cause of head injuries. Although the head injury criterion has been beneficial as an indicator of head injury risk, it only considers linear acceleration, so there is a need to consider both types of motion in future safety standards. Advanced models of the head/brain complex have recently been developed to gain a better understanding of head injury biomechanics. While these models have been verified against laboratory experimental data, there is a lack of suitable real-world data available for validation. Hence, using two computer models of the head/brain, the objective of the current study was to reconstruct four real-world crashes with known head injury outcomes in a full-vehicle crash laboratory, simulate head/brain responses using kinematics obtained during these reconstructions, and to compare the results predicted by the models against the actual injuries sustained by the occupant. Cases where the occupant sustained no head injuries (AIS 0) and head injuries of severity AIS 4, AIS 5, and multiple head injuries were selected. Data collected from a 9-accelerometer skull were input into the Wayne State University Head Injury Model (WSUHIM) and the NHTSA Simulated Injury Monitor (SIMon). The results demonstrated that both models were able to predict varying injury severities consistent with the difference in AIS injury levels in the real-world cases. The WSUHIM predicted a slightly higher injury threshold than the SIMon, probably due to the finer mesh and different software used for the simulations, and could also determine regions of the brain which had been injured. With further validation, finite element models can be used to establish an injury criterion for each type of brain injury in the future. PMID:17096266

  17. Identification of femoral head center of bipolar hemiarthroplasy in radiostereometric analysis with elementary geometrical shape models.

    PubMed

    Tsukanaka, Masako; Röhrl, Stephan M; von Schewelov, Thord; Nordsletten, Lars

    2016-02-01

    Elementary geometrical shape (EGS) models are useful in radiostereometric analysis (RSA) on hip stems because tantalum markers attached to the stems can be omitted. In order to create an EGS model of a femoral stem, the center of the femoral head has to be identified. The contour of the femoral head is recommended to be used. However, the contour of the femoral head cannot be detected exclusively by computer if it is combined with a bipolar head or a metal cup. We therefore hypothesized that the contour of the outer head of bipolar hemiarthroplasty can be included in the EGS model as well as the femoral head contour. We calculated the time required for the detection of the contour, the precision of analysis and the stem micromotion at 2 years using the two different methods in the same picture set and compared the results. The detection of the bipolar head contour was 10 times faster than that of the femoral head contour. The precision for subsidence was 0.16 mm in EGS RSA with the femoral head contour, and 0.15 mm with the bipolar head contour (p=0.68). The precisions were comparable and clinically acceptable. There was no significant difference between the results of the 2-year micromotion with the two different methods. We conclude that this new method is applicable to measure stem micromotion of hemi-arthroplasty with EGS RSA and the method facilitates the Radiostereometric analysis. PMID:26705109

  18. A Drosophila model of closed head traumatic brain injury

    PubMed Central

    Katzenberger, Rebeccah J.; Loewen, Carin A.; Wassarman, Douglas R.; Petersen, Andrew J.; Ganetzky, Barry; Wassarman, David A.

    2013-01-01

    Traumatic brain injury (TBI) is a substantial health issue worldwide, yet the mechanisms responsible for its complex spectrum of pathologies remains largely unknown. To investigate the mechanisms underlying TBI pathologies, we developed a model of TBI in Drosophila melanogaster. The model allows us to take advantage of the wealth of experimental tools available in flies. Closed head TBI was inflicted with a mechanical device that subjects flies to rapid acceleration and deceleration. Similar to humans with TBI, flies with TBI exhibited temporary incapacitation, ataxia, activation of the innate immune response, neurodegeneration, and death. Our data indicate that TBI results in death shortly after a primary injury only if the injury exceeds a certain threshold and that age and genetic background, but not sex, substantially affect this threshold. Furthermore, this threshold also appears to be dependent on the same cellular and molecular mechanisms that control normal longevity. This study demonstrates the potential of flies for providing key insights into human TBI that may ultimately provide unique opportunities for therapeutic intervention. PMID:24127584

  19. Closed-Head TBI Model of Multiple Morbidity.

    PubMed

    Thompson, Floyd J; Hou, Jiamei; Bose, Prodip K

    2016-01-01

    Successful therapy for TBI disabilities awaits refinement in the understanding of TBI neurobiology, quantitative measurement of treatment-induced incremental changes in recovery trajectories, and effective translation to human TBI using quantitative methods and protocols that were effective to monitor recovery in preclinical models. Details of the specific neurobiology that underlies these injuries and effective quantitation of treatment-induced changes are beginning to emerge utilizing a variety of preclinical and clinical models (for reviews see (Morales et al., Neuroscience 136:971-989, 2005; Fujimoto et al., Neurosci Biobehav Rev 28:365-378, 2004; Cernak, NeuroRx 2:410-422, 2005; Smith et al., J Neurotrauma 22:1485-1502, 2005; Bose et al., J Neurotrauma 30:1177-1191, 2013; Xiong et al., Nat Rev Neurosci 14:128-142, 2013; Xiong et al., Expert Opin Emerg Drugs 14:67-84, 2009; Johnson et al., Handb Clin Neurol 127:115-128, 2015; Bose et al., Brain neurotrauma: molecular, neuropsychological, and rehabilitation aspects, CRC Press/Taylor & Francis, Boca Raton, 2015)). Preclinical models of TBI, essential for the efficient study of TBI neurobiology, benefit from the setting of controlled injury and optimal opportunities for biometric quantitation of injury and treatment-induced changes in the trajectories of disability. Several preclinical models are currently used, and each offer opportunities for study of different aspects of TBI primary and secondary injuries (for review see (Morales et al., Neuroscience 136:971-989, 2005; Xiong et al., Nat Rev Neurosci 14:128-142, 2013; Xiong et al., Expert Opin Emerg Drugs 14:67-84, 2009; Johnson et al., Handb Clin Neurol 127:115-128, 2015; Dixon et al., J Neurotrauma 5:91-104, 1988)). The closed-head, impact-acceleration model of TBI designed by Marmarou et al., 1994 (J Neurosurg 80:291-300, 1994), when used to produce mild to moderate TBI, produces diffuse axonal injuries without significant additional focal injuries of the

  20. A kinematic model for 3-D head-free gaze-shifts

    PubMed Central

    Daemi, Mehdi; Crawford, J. Douglas

    2015-01-01

    Rotations of the line of sight are mainly implemented by coordinated motion of the eyes and head. Here, we propose a model for the kinematics of three-dimensional (3-D) head-unrestrained gaze-shifts. The model was designed to account for major principles in the known behavior, such as gaze accuracy, spatiotemporal coordination of saccades with vestibulo-ocular reflex (VOR), relative eye and head contributions, the non-commutativity of rotations, and Listing's and Fick constraints for the eyes and head, respectively. The internal design of the model was inspired by known and hypothesized elements of gaze control physiology. Inputs included retinocentric location of the visual target and internal representations of initial 3-D eye and head orientation, whereas outputs were 3-D displacements of eye relative to the head and head relative to shoulder. Internal transformations decomposed the 2-D gaze command into 3-D eye and head commands with the use of three coordinated circuits: (1) a saccade generator, (2) a head rotation generator, (3) a VOR predictor. Simulations illustrate that the model can implement: (1) the correct 3-D reference frame transformations to generate accurate gaze shifts (despite variability in other parameters), (2) the experimentally verified constraints on static eye and head orientations during fixation, and (3) the experimentally observed 3-D trajectories of eye and head motion during gaze-shifts. We then use this model to simulate how 2-D eye-head coordination strategies interact with 3-D constraints to influence 3-D orientations of the eye-in-space, and the implications of this for spatial vision. PMID:26113816

  1. A kinematic model for 3-D head-free gaze-shifts.

    PubMed

    Daemi, Mehdi; Crawford, J Douglas

    2015-01-01

    Rotations of the line of sight are mainly implemented by coordinated motion of the eyes and head. Here, we propose a model for the kinematics of three-dimensional (3-D) head-unrestrained gaze-shifts. The model was designed to account for major principles in the known behavior, such as gaze accuracy, spatiotemporal coordination of saccades with vestibulo-ocular reflex (VOR), relative eye and head contributions, the non-commutativity of rotations, and Listing's and Fick constraints for the eyes and head, respectively. The internal design of the model was inspired by known and hypothesized elements of gaze control physiology. Inputs included retinocentric location of the visual target and internal representations of initial 3-D eye and head orientation, whereas outputs were 3-D displacements of eye relative to the head and head relative to shoulder. Internal transformations decomposed the 2-D gaze command into 3-D eye and head commands with the use of three coordinated circuits: (1) a saccade generator, (2) a head rotation generator, (3) a VOR predictor. Simulations illustrate that the model can implement: (1) the correct 3-D reference frame transformations to generate accurate gaze shifts (despite variability in other parameters), (2) the experimentally verified constraints on static eye and head orientations during fixation, and (3) the experimentally observed 3-D trajectories of eye and head motion during gaze-shifts. We then use this model to simulate how 2-D eye-head coordination strategies interact with 3-D constraints to influence 3-D orientations of the eye-in-space, and the implications of this for spatial vision. PMID:26113816

  2. Bayesian model averaging for groundwater head prediction and uncertainty analysis using multimodel and multimethod

    NASA Astrophysics Data System (ADS)

    Li, Xiaobao; Tsai, Frank T.-C.

    2009-09-01

    This study introduces a Bayesian model averaging (BMA) method that incorporates multiple groundwater models and multiple hydraulic conductivity estimation methods to predict groundwater heads and evaluate prediction uncertainty. BMA is able to distinguish prediction uncertainty arising from individual models, between models, and between methods. Moreover, BMA is able to identify unfavorable models even though they may present small prediction uncertainty. Uncertainty propagation, from model parameter uncertainty to model prediction uncertainty, can also be studied through BMA. This study adopts a variance window to obtain reasonable BMA weights for the best models, which are usually exaggerated by Occam's window. Results from a synthetic case study show that BMA with the variance window can provide better head prediction than individual models, or at least can obtain better predictions close to the best model. The BMA was applied to predicting groundwater heads in the "1500-foot" sand of the Baton Rouge area in Louisiana. Head prediction uncertainty was assessed by the BMA prediction variance. BMA confirms that large head prediction uncertainty occurs at areas lacking head observations and hydraulic conductivity measurements. Further study in these areas is necessary to reduce head prediction uncertainty.

  3. Thrust and torque characteristics based on a new cutter-head load model

    NASA Astrophysics Data System (ADS)

    Liu, Jianqin; Ren, Jiabao; Guo, Wei

    2015-07-01

    Full face rock tunnel boring machine(TBM) has been widely used in hard rock tunnels, however, there are few published theory about cutter-head design, and the design criteria of cutter-head under complex geological is not clear yet. To deal with the complex relationship among geological parameters, cutter parameters, and operating parameters during tunneling processes, a cutter-head load model is established by using CSM(Colorado school of mines) prediction model. Force distribution on cutter-head under a certain geology is calculated with the new established load model, and result shows that inner cutters bear more force than outer cutters, combining with disc cutters abrasion; a general principle of disc cutters' layout design is proposed. Within the model, the relationship among rock uniaxial compressive strength(UCS), penetration and thrust on cutter-head are analyzed, and the results shows that with increasing penetration, cutter thrust increases, but the growth rate slows and higher penetration makes lower special energy(SE). Finally, a fitting mathematical model of ZT(ratio of cutter-head torque and thrust) and penetration is established, and verified by TB880E, which can be used to direct how to set thrust and torque on cutter-head. When penetration is small, the cutter-head thrust is the main limiting factor in tunneling; when the penetration is large, cutter-head torque is the major limiting factor in tunneling. Based on the new cutter-head load model, thrust and torque characteristics of TBM further are researched and a new way for cutter-head layout design and TBM tunneling operations is proposed.

  4. Osteonecrosis of the jaws and bisphosphonates. Report of three cases.

    PubMed

    Pastor-Zuazaga, Daniel; Garatea-Crelgo, Joaquín; Martino-Gorbea, Raúl; Etayo-Pérez, Amaya; Sebastián-López, Cristina

    2006-01-01

    Bisphosphonates are recently acquiring increasing relevance in the treatment of several diseases. In line with the increased use of these compounds, cases of mandibular osteonecrosis, and to a lesser extent, maxillary osteonecrosis, are being reported. This necrosis is difficult to treat in patients who usually have a previously limited quality of life. A surgical performance carried out by oral and maxillofacial surgeons, stomatologists and odontologists might lead to bone exposure. A treatment based on conservation and as harmless as possible seems to be the most advisable way of acting with these patients in order to minimize the incidence and treat the complications, once the lesions have been ascertained. We report three cases treated in our service of osteonecrosis of the jaws after exodontics. This side effect should be remembered before starting any surgical treatment in these patients. PMID:16388300

  5. [Sunitinib and zoledronic acid induced osteonecrosis of the jaw].

    PubMed

    Soós, Balázs; Vajta, László; Szalma, József

    2015-11-15

    The tendency for bisphosphonate and non-bisphosphonate (eg.: antiresorptive or anti-angiogenesis drugs) induced osteonecrosis is increasing. Treatment of these patients is a challenge both for dentists and for oral and maxillofacial surgeons. Cooperation with the drug prescribing general medicine colleagues to prevent osteonecrosis is extremely important. Furthermore, prevention should include dental focus elimination, oral hygienic instructions and education, dental follow-up and, in case of manifest necrosis, referral to maxillofacial departments. Authors outline the difficulties of conservative and surgical treatment of a patient with sunitinib and zoledronic acid induced osteonecrosis. The patient became symptomless and the operated area healed entirely six and twelve months postoperatively. A long term success further follow-up is necessary to verify long-term success. PMID:26548471

  6. Bisphosphonates and time to osteonecrosis development.

    PubMed

    Palaska, Pinelopi Kleio; Cartsos, Vassiliki; Zavras, Athanasios I

    2009-11-01

    Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is a complication of long-term bisphosphonate (BP) use. Given the beneficial effects of BP on bone quality in patients with cancer or osteoporosis, it is of great importance to understand the risk as it relates to time to event or cumulative dose until the onset of disease. Because there is no information on the lowest toxic dose from clinical trials, here we report on a review of 71 case series published since 2003. We calculated the weighted mean time to event, as well as the minimum reported time and dose for zoledronate, pamidronate, and oral bisphosphonates. The mean time to BONJ after zoledronate treatment was calculated at 1.8 years and the minimum was 10 months; after pamidronate, the mean time was 2.8 years and the minimum was 1.5 years; and after oral BP therapy, the mean time was 4.6 years and the minimum was 3 years. Zoledronic acid seems to be the most potent among the nitrogen-containing BPs. Factors that seem to affect BONJ and time to event were invasive dental procedures and other comorbid factors such as advanced age, rheumatoid arthritis, diabetes, use of corticosteroids, vitamin D deficiency, and more. Understanding the pathophysiology of the disease requires further research. PMID:19897878

  7. [Bisphosphonate-related osteonecrosis of the jaw].

    PubMed

    Franken, Anton A M; van Blijderveen, Nico J C; Witjes, Max J H; Netelenbos, Coen J C

    2011-01-01

    Osteonecrosis of the jaw in association with long-term use of bisphosphonates (BRONJ) is a relatively rare but serious side effect that is difficult to treat. The incidence of BRONJ in patients treated for osteoporosis is low at 0.1%. The incidence in cancer patients treated with high doses of intravenous bisphosphonates is higher, ranging between 3% and 10%. Risk factors for BRONJ are invasive treatments such as tooth extractions, root canal procedures and the placement of dental implants, as well as trauma caused by pressure from poorly fitting dental prostheses. High-risk patients should be examined by a dentist or an oral surgeon and, if necessary, undergo dental treatment prior to treatment with bisphosphonates. All patients taking bisphosphonates should maintain good oral hygiene, receive regular dental examinations and see a dentist if any oral symptoms develop. Physicians who prescribe medication as well as the patient's dentist and oral surgeon should be aware of the use of bisphosphonates and BRONJ as a possible adverse reaction. This requires cooperation and the exchange of information between a patient's health care providers. PMID:21486510

  8. Aseptic osteonecrosis of the hip in the adult: current evidence on conservative treatment.

    PubMed

    Klumpp, Raymond; Trevisan, Carlo

    2015-01-01

    Treatment of Avascular Osteonecrosis (AVN) of the femoral head to prevent progression to an arthritic hip is a challenging subject. Many conservative treatment options have been proposed in the literature. Weight bearing restriction as a stand-alone therapy is insufficient in preventing disease progression but it may be useful when combined with pharmacological agents or surgery. Bisphosphonate treatment in AVN might be efficient in early stages of disease, however there are no clear recommendations on length of treatment and therapeutic dosage and, considered the limited evidence and potential side effects of treatment, it could be considered in a pre-collapse stage in selected cases. Current literature suggests that low molecular weight heparin could lower disease progression in idiopathic AVN with quality of evidence being very low. Also the evidence to support the use of statins or vasodilators in the treatment of osteonecrosis is very low and their use cannot be recommended. Extracorporeal shock wave therapy may improve pain and function in early stages of disease with a low evidence, but there doesn't seem to be a significant change in time to the occurrence of femoral head collapse. Only one study has been conducted with pulsed electromagnetic fields therefore no recommendation can be given on clinical use of PEF in AVN. Evidence on hyperbaric oxygen therapy in the treatment of AVN is very limited and the high cost of treatment and the limited availability of structures that can provide the service poses other concerns about its feasibility. Based on current evidence, conservative treatment may be considered in early stages of asymptomatic AVN instead of observation only. PMID:27134631

  9. Aseptic osteonecrosis of the hip in the adult: current evidence on conservative treatment

    PubMed Central

    Klumpp, Raymond; Trevisan, Carlo

    2015-01-01

    Summary Treatment of Avascular Osteonecrosis (AVN) of the femoral head to prevent progression to an arthritic hip is a challenging subject. Many conservative treatment options have been proposed in the literature. Weight bearing restriction as a stand-alone therapy is insufficient in preventing disease progression but it may be useful when combined with pharmacological agents or surgery. Bisphosphonate treatment in AVN might be efficient in early stages of disease, however there are no clear recommendations on length of treatment and therapeutic dosage and, considered the limited evidence and potential side effects of treatment, it could be considered in a pre-collapse stage in selected cases. Current literature suggests that low molecular weight heparin could lower disease progression in idiopathic AVN with quality of evidence being very low. Also the evidence to support the use of statins or vasodilators in the treatment of osteonecrosis is very low and their use cannot be recommended. Extracorporeal shock wave therapy may improve pain and function in early stages of disease with a low evidence, but there doesn’t seem to be a significant change in time to the occurrence of femoral head collapse. Only one study has been conducted with pulsed electromagnetic fields therefore no recommendation can be given on clinical use of PEF in AVN. Evidence on hyperbaric oxygen therapy in the treatment of AVN is very limited and the high cost of treatment and the limited availability of structures that can provide the service poses other concerns about its feasibility. Based on current evidence, conservative treatment may be considered in early stages of asymptomatic AVN instead of observation only. PMID:27134631

  10. Risk Factors in the Development of Oral Bisphosphonate-induced Osteonecrosis.

    PubMed

    Reiss, Stacey; Sultan, Daniel

    2015-11-01

    Bisphosphonates (BPs) are routinely prescribed to prevent pathologic fractures in osteoporotic patients. Bisphosphonate-associated osteonecrosis of the jaw (BRONJ) is a rare, but serious complication, most often following extraction in patients treated with intravenous BPs. We report a case of BRONJ in a patient following six years of oral BP administration for the management of osteoporosis, complicated by four years of prednisone therapy for pulmonary fibrosis. This rare presentation led us to investigate other causative factors, in particular, glucocorticoids. This report aims to construct a clinically relevant predictive model of the disease through better understanding of concomitant risk factors. PMID:26749781

  11. Effects of Head Models and Dipole Source Parameters on EEG Fields

    PubMed Central

    Peng, Li; Peng, Mingming; Xu, Anhuai

    2015-01-01

    Head model and an efficient method for computing the forward EEG (electroencephalography)problem are essential to dipole source localization(DSL). In this paper, we use less expensive ovoid geometry to approximate human head, aiming at investigating the effects of head shape and dipole source parameters on EEG fields. The application of point least squares (PLS) based on meshless method was introduced for solving EEG forward problem and numerical simulation is implemented in three kinds of ovoid head models. We present the performances of the surface potential in the face of varying dipole source parameters in detail. The results show that the potential patterns are similar for different dipole position in different head shapes, but the peak value of potential is significantly influenced by the head shape. Dipole position induces a great effect on the peak value of potential and shift of peak potential. The degree of variation between sphere head model and non-sphere head models is seen at the same time. We also show that PLS method with the trigonometric basis is superior to the constant basis, linear basis, and quadratic basis functions in accuracy and efficiency. PMID:25893011

  12. Constructing three-dimensional detachable and composable computer models of the head and neck.

    PubMed

    Fan, Min; Dai, Peishan; Zheng, Buhong; Li, Xinchun

    2015-06-01

    The head and neck region has a complex spatial and topological structure, three-dimensional (3D) computer model of the region can be used in anatomical education, radiotherapy planning and surgical training. However, most of the current models only consist of a few parts of the head and neck, and the 3D models are not detachable and composable. In this study, a high-resolution 3D detachable and composable model of the head and neck was constructed based on computed tomography (CT) serial images. First, fine CT serial images of the head and neck were obtained. Then, a color lookup table was created for 58 structures, which was used to create anatomical atlases of the head and neck. Then, surface and volume rendering methods were used to reconstruct 3D models of the head and neck. Smoothing and polygon reduction steps were added to improve 3D rendering effects. 3D computer models of the head and neck, including the sinus, pharynx, vasculature, nervous system, endocrine system and glands, muscles, bones and skin, were reconstructed. The models consisted of 58 anatomical detachable and composable structures and each structure can be displayed individually or together with other structures. PMID:26091713

  13. Head out of water immersion: A simulation model of microgravity?

    NASA Astrophysics Data System (ADS)

    Verheyden, B.; Beckers, F.; Aubert, Ae.

    Introduction. It is well known that during weightlessness a redistribution of body fluids occurs towards the upper parts of the body causing altered cardiovascular reflex activities. During head out of water immersion (HOI), the hydrostatic pressure on the soft tissues of the lower limbs causes thoracic blood volume to increase, comparably with the observed haemodynamics during weightlessness. The purpose of this study was to evaluate HOI as a simulation model of microgravity concerning the cardiovascular autonomic control system. Methods. Heartbeat and continuous blood pressure (fingerplethysmography) were measured in 18 (age=22.2± 10.3yr) healthy subjects in different conditions: Supine, sitting and standing in air (25C); upright submersion in thermo neutral water (34C) up to the shoulders (HOI). After 5 minutes of accommodation to the position and condition, recordings were made for 10 minutes. Time domain parameters (MeanRR, SD, rMSSD and pNN50) as well as frequency domain parameters (Total Power, high frequency (HF), low frequency (LF)) of HRV and BPV were calculated. An index of baroreflex sensitivity was determined by the sequence method. Results from the HOI experiment were compared to results obtained from microgravity phases in parabolic flights in 5 subjects. Results. Cardiac autonomic control during HOI was characterized by a gain in vagal predominance as shown by a decrease of the LF/HF-ratio from 950 ± 130 ms2 during standing control towards 389 ± 119 ms2 during HOI and a increase of BRS by approximately 20%. As a result, heart rate decreased by approximately 28% during HOI. The same evolution was shown during the transition from a standing control position towards 0G obtained during parabolic flights. LF power of BPV, as a marker of peripheral vasomotor sympathetic activity, decreased significantly both in absolute values and normalized units during HOI compared to standing and seated control (p < 0.05). In contrast, an increase in LF power of BPV

  14. Development/global validation of a 6-month-old pediatric head finite element model and application in investigation of drop-induced infant head injury.

    PubMed

    Li, Zhigang; Luo, Xiao; Zhang, Jinhuan

    2013-12-01

    Drop is a frequent cause for infant head injury. To date, finite element (FE) modeling was gradually used to investigate child head dynamic response under drop impact conditions, however, two shortages still exist on this topic: (1) due to ethical reasons, none of developed 6-month-old (6MO) head FE model was found to be quantitatively validated against child cadaver tests at similar age group; (2) drop height and impact surface stiffness effects on infant head responses were not comprehensively investigated. In this study, motivated by the recently published material properties of soft tissues (skull and suture, etc.) and reported pediatric head global cadaver tests, a 6MO child head FE model was developed and simulated results compared with the child cadaver experimental data under compression and drop conditions. Comparison of results indicated that the FE model showed a fairly good biofidelic behavior in most dynamic responses. The validated FE model was further used to investigate effects of different drop heights and impact surface stiffness on the head dynamic responses. Numerical results show that the pediatric head mechanical parameters (peak acceleration, HIC, maximal vonMises stress and maximal first principal strain of skull) keep increasing with the increase in drop height, and exhibit "logarithmic function" shapes at "fast-slow" trends with increase in impact surface stiffness. Based on above analysis, the regressions were conducted to describe the relationship between drop height and impact surface stiffness and head global injury predictors (head peak acceleration, HIC, etc.). This paper provides a fundamental study of child head injury mechanism and protection under drop conditions. PMID:24008251

  15. Development, Validation and Parametric study of a 3-Year-Old Child Head Finite Element Model

    NASA Astrophysics Data System (ADS)

    Cui, Shihai; Chen, Yue; Li, Haiyan; Ruan, ShiJie

    2015-12-01

    Traumatic brain injury caused by drop and traffic accidents is an important reason for children's death and disability. Recently, the computer finite element (FE) head model has been developed to investigate brain injury mechanism and biomechanical responses. Based on CT data of a healthy 3-year-old child head, the FE head model with detailed anatomical structure was developed. The deep brain structures such as white matter, gray matter, cerebral ventricle, hippocampus, were firstly created in this FE model. The FE model was validated by comparing the simulation results with that of cadaver experiments based on reconstructing the child and adult cadaver experiments. In addition, the effects of skull stiffness on the child head dynamic responses were further investigated. All the simulation results confirmed the good biofidelity of the FE model.

  16. Influence of head mass on temporo-parietal skull impact using finite element modeling.

    PubMed

    Sahoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy

    2015-09-01

    The effect of head mass on its biomechanical response during lateral impact to the head is investigated in this computational study. The mass of the head of a state-of-the-art validated finite element head model is altered by ± 10 % from the base value of 4.7 kg. Numerical simulations of lateral head impacts for 30 cases (representing 15 human cadaver experiments × 2 mass configurations) are performed using the LS-DYNA solver at different velocities ranging from 2.4 to 6.5 m/s and three impacting conditions representing different stiffness and shapes of the contact/impact surfaces. Results are compared with the original model using the baseline head mass, thus resulting in a total of 45 simulations. Present findings show that the head mass has greater influence for peak interaction forces and the force has a greater dependency on stiffness of contact surface than the shape. Mass variations have also influence on skull strain energy. Regardless of increase/decrease in skull strain energy influenced by head mass variations used in the computational study, the 50 % fracture tolerance limit was unaltered, which was 544 mJ. The present study gives a better understanding of the mechanism of temporo-parietal skull impact. PMID:25863692

  17. Comparison of a layered slab and an atlas head model for Monte Carlo fitting of time-domain near-infrared spectroscopy data of the adult head

    NASA Astrophysics Data System (ADS)

    Selb, Juliette; Ogden, Tyler M.; Dubb, Jay; Fang, Qianqian; Boas, David A.

    2014-01-01

    Near-infrared spectroscopy (NIRS) estimations of the adult brain baseline optical properties based on a homogeneous model of the head are known to introduce significant contamination from extracerebral layers. More complex models have been proposed and occasionally applied to in vivo data, but their performances have never been characterized on realistic head structures. Here we implement a flexible fitting routine of time-domain NIRS data using graphics processing unit based Monte Carlo simulations. We compare the results for two different geometries: a two-layer slab with variable thickness of the first layer and a template atlas head registered to the subject's head surface. We characterize the performance of the Monte Carlo approaches for fitting the optical properties from simulated time-resolved data of the adult head. We show that both geometries provide better results than the commonly used homogeneous model, and we quantify the improvement in terms of accuracy, linearity, and cross-talk from extracerebral layers.

  18. Bone end sclerosis in renal osteodystrophy simulating osteonecrosis

    SciTech Connect

    Van Lewis, L.; Keats, T.E.

    1982-08-01

    Osteosclerosis of the bone ends is an unusual manifestation of renal osteodystrophy. In evaluating this finding one should be careful to exclude clinical and radiographic evidence for osteonecrosis. In the two known cases of this entity, bone end sclerosis has been found to develop over one to two years with symmetrical involvement of multiple bones.

  19. Realistic avatar eye and head animation using a neurobiological model of visual attention

    NASA Astrophysics Data System (ADS)

    Itti, Laurent; Dhavale, Nitin; Pighin, Frederic

    2004-01-01

    We describe a neurobiological model of visual attention and eye/head movements in primates, and its application to the automatic animation of a realistic virtual human head watching an unconstrained variety of visual inputs. The bottom-up (image-based) attention model is based on the known neurophysiology of visual processing along the occipito-parietal pathway of the primate brain, while the eye/head movement model is derived from recordings in freely behaving Rhesus monkeys. The system is successful at autonomously saccading towards and tracking salient targets in a variety of video clips, including synthetic stimuli, real outdoors scenes and gaming console outputs. The resulting virtual human eye/head animation yields realistic rendering of the simulation results, both suggesting applicability of this approach to avatar animation and reinforcing the plausibility of the neural model.

  20. A Head in Virtual Reality: Development of A Dynamic Head and Neck Model

    ERIC Educational Resources Information Center

    Nguyen, Ngan; Wilson, Timothy D.

    2009-01-01

    Advances in computer and interface technologies have made it possible to create three-dimensional (3D) computerized models of anatomical structures for visualization, manipulation, and interaction in a virtual 3D environment. In the past few decades, a multitude of digital models have been developed to facilitate complex spatial learning of the…

  1. A finite-element reciprocity solution for EEG forward modeling with realistic individual head models.

    PubMed

    Ziegler, Erik; Chellappa, Sarah L; Gaggioni, Giulia; Ly, Julien Q M; Vandewalle, Gilles; André, Elodie; Geuzaine, Christophe; Phillips, Christophe

    2014-12-01

    We present a finite element modeling (FEM) implementation for solving the forward problem in electroencephalography (EEG). The solution is based on Helmholtz's principle of reciprocity which allows for dramatically reduced computational time when constructing the leadfield matrix. The approach was validated using a 4-shell spherical model and shown to perform comparably with two current state-of-the-art alternatives (OpenMEEG for boundary element modeling and SimBio for finite element modeling). We applied the method to real human brain MRI data and created a model with five tissue types: white matter, gray matter, cerebrospinal fluid, skull, and scalp. By calculating conductivity tensors from diffusion-weighted MR images, we also demonstrate one of the main benefits of FEM: the ability to include anisotropic conductivities within the head model. Root-mean square deviation between the standard leadfield and the leadfield including white-matter anisotropy showed that ignoring the directional conductivity of white matter fiber tracts leads to orientation-specific errors in the forward model. Realistic head models are necessary for precise source localization in individuals. Our approach is fast, accurate, open-source and freely available online. PMID:25204867

  2. Principle Study of Head Meridian Acupoint Massage to Stress Release via Grey Data Model Analysis

    PubMed Central

    Lee, Ya-Ting

    2016-01-01

    This paper presents the scientific study of the effectiveness and action principle of head meridian acupoint massage by applying the grey data model analysis approach. First, the head massage procedure for massaging the important head meridian acupuncture points including Taiyang, Fengfu, Tianzhu, Fengqi, and Jianjing is formulated in a standard manner. Second, the status of the autonomic nervous system of each subject is evaluated by using the heart rate variability analyzer before and after the head massage following four weeks. Afterward, the physiological factors of autonomic nerves are quantitatively analyzed by using the grey data modeling theory. The grey data analysis can point out that the status of autonomic nervous system is greatly improved after the massage. The order change of the grey relationship weighting of physiological factors shows the action principle of the sympathetic and parasympathetic nerves when performing head massage. In other words, the grey data model is able to distinguish the detailed interaction of the autonomic nervous system and the head meridian acupoint massage. Thus, the stress relaxing effect of massaging head meridian acupoints is proved, which is lacked in literature. The results can be a reference principle for massage health care in practice. PMID:26904144

  3. Double-ring network model of the head-direction system

    NASA Astrophysics Data System (ADS)

    Xie, Xiaohui; Hahnloser, Richard H.; Seung, H. Sebastian

    2002-10-01

    In the head-direction system, the orientation of an animal's head in space is encoded internally by persistent activities of a pool of cells whose firing rates are tuned to the animal's directional heading. To maintain an accurate representation of the heading information when the animal moves, the system integrates horizontal angular head-velocity signals from the vestibular nuclei and updates the representation of directional heading. The integration is a difficult process, given that head velocities can vary over a large range and the neural system is highly nonlinear. Previous models of integration have relied on biologically unrealistic mechanisms, such as instantaneous changes in synaptic strength, or very fast synaptic dynamics. In this paper, we propose a different integration model with two populations of neurons, which performs integration based on the differential input of the vestibular nuclei to these two populations. We mathematically analyze the dynamics of the model and demonstrate that with carefully tuned synaptic connections it can accurately integrate a large range of the vestibular input, with potentially slow synapses.

  4. Principle Study of Head Meridian Acupoint Massage to Stress Release via Grey Data Model Analysis.

    PubMed

    Lee, Ya-Ting

    2016-01-01

    This paper presents the scientific study of the effectiveness and action principle of head meridian acupoint massage by applying the grey data model analysis approach. First, the head massage procedure for massaging the important head meridian acupuncture points including Taiyang, Fengfu, Tianzhu, Fengqi, and Jianjing is formulated in a standard manner. Second, the status of the autonomic nervous system of each subject is evaluated by using the heart rate variability analyzer before and after the head massage following four weeks. Afterward, the physiological factors of autonomic nerves are quantitatively analyzed by using the grey data modeling theory. The grey data analysis can point out that the status of autonomic nervous system is greatly improved after the massage. The order change of the grey relationship weighting of physiological factors shows the action principle of the sympathetic and parasympathetic nerves when performing head massage. In other words, the grey data model is able to distinguish the detailed interaction of the autonomic nervous system and the head meridian acupoint massage. Thus, the stress relaxing effect of massaging head meridian acupoints is proved, which is lacked in literature. The results can be a reference principle for massage health care in practice. PMID:26904144

  5. Hand effect on head specific absorption rate (SAR) exposed by two realistic phone models

    NASA Astrophysics Data System (ADS)

    Keshvari, J.; Kivento, M.

    2013-04-01

    There have been some reports about possible effect of the hand presence on the head SAR if hand phantom is included in the measurements of the head SAR compliance assessment procedure. The objective of this computational study was to examine the reported effect by using realistic head models and realistic CAD based phone models. A commercially available FDTD based EM solver was used to carry out the computational work. Based on the results of this study considering the SAR values without hand phantom as reference, following conclusions can be made: 1. In general presence of the hand lead to significantly less conservative SAR values in the head for large majority of cases 2. For lower band GSM frequencies the presence of the hand decreases the head SAR up to ~70%. 3. For the upper band GSM frequencies the presence of the hand decreases the head SAR up to ~55%. Based on the results of this study the present SAR compliance protocol where hand phantom is not included leads to more conservative head SAR results compared to the cases where hand is included.

  6. Biomechanical studies in an ovine model of non-accidental head injury.

    PubMed

    Anderson, R W G; Sandoz, B; Dutschke, J K; Finnie, J W; Turner, R J; Blumbergs, P C; Manavis, J; Vink, R

    2014-08-22

    This paper presents the head kinematics of a novel ovine model of non-accidental head injury (NAHI) that consists only of a naturalistic oscillating insult. Nine, 7-to-10-day-old anesthetized and ventilated lambs were subjected to manual shaking. Two six-axis motion sensors tracked the position of the head and torso, and a triaxial accelerometer measured head acceleration. Animals experienced 10 episodes of shaking over 30 min, and then remained under anesthesia for 6h until killed by perfusion fixation of the brain. Each shaking episode lasted for 20s resulting in about 40 cycles per episode. Each cycle typically consisted of three impulsive events that corresponded to specific phases of the head's motion; the most substantial of these were interactions typically with the lamb's own torso, and these generated accelerations of 30-70 g. Impulsive loading was not considered severe. Other kinematic parameters recorded included estimates of head power transfer, head-torso flexion, and rate of flexion. Several styles of shaking were also identified across episodes and subjects. Axonal injury, neuronal reaction and albumin extravasation were widely distributed in the hemispheric white matter, brainstem and at the craniocervical junction and to a much greater magnitude in lower body weight lambs that died. This is the first biomechanical description of a large animal model of NAHI in which repetitive naturalistic insults were applied, and that reproduced a spectrum of injury associated with NAHI. PMID:24974335

  7. [Developing a finite element model of human head with true anatomic structure mandible].

    PubMed

    Ma, Chunsheng; Zhang, Haizhong; Du, Huiliang; Huang, Shilin; Zhang, Jinhuan

    2005-02-01

    A finite element model of human mandible is developed from CT scan images by the technologies of three-dimensional reconstruction, image processing and meshing. The mandible model is connected to one modified head model of Hybrid III dummy with joint according to the anatomic structure and mechanical characteristics of the temporomandibular joint. Then a finite element model of the human head with the true anatomic structure mandible is developed. This model has been validated with the cadaver test results. It can be used in researches on the mechanism of craniofacial blunt-impact injury and on the assessment of injury severity. PMID:15762115

  8. Development of head injury assessment reference values based on NASA injury modeling.

    PubMed

    Somers, Jeffrey T; Granderson, Bradley; Melvin, John W; Tabiei, Ala; Lawrence, Charles; Feiveson, Alan; Gernhardt, Michael; Ploutz-Snyder, Robert; Patalak, John

    2011-11-01

    NASA is developing a new crewed vehicle and desires a lower risk of injury compared to automotive or commercial aviation. Through an agreement with the National Association of Stock Car Auto Racing, Inc. (NASCAR®), an analysis of NASCAR impacts was performed to develop new injury assessment reference values (IARV) that may be more relevant to NASA's context of vehicle landing operations. Head IARVs associated with race car impacts were investigated by analyzing all NASCAR recorded impact data for the 2002-2008 race seasons. From the 4015 impact files, 274 impacts were selected for numerical simulation using a custom NASCAR restraint system and Hybrid III 50th percentile male Finite Element Model (FEM) in LS-DYNA. Head injury occurred in 27 of the 274 selected impacts, and all of the head injuries were mild concussions with or without brief loss of consciousness. The 247 noninjury impacts selected were representative of the range of crash dynamics present in the total set of impacts. The probability of head injury was estimated for each metric using an ordered probit regression analysis. Four metrics had good correlation with the head injury data: head resultant acceleration, head change in velocity, HIC 15, and HIC 36. For a 5% risk of AIS≥1/AIS≥2 head injuries, the following IARVs were found: 121.3/133.2 G (head resultant acceleration), 20.3/22.0 m/s (head change in velocity), 1,156/1,347 (HIC 15), and 1,152/1,342 (HIC 36) respectively. Based on the results of this study, further analysis of additional datasets is recommended before applying these results to future NASA vehicles. PMID:22869304

  9. Modeling heading and path perception from optic flow in the case of independently moving objects

    PubMed Central

    Raudies, Florian; Neumann, Heiko

    2013-01-01

    Humans are usually accurate when estimating heading or path from optic flow, even in the presence of independently moving objects (IMOs) in an otherwise rigid scene. To invoke significant biases in perceived heading, IMOs have to be large and obscure the focus of expansion (FOE) in the image plane, which is the point of approach. For the estimation of path during curvilinear self-motion no significant biases were found in the presence of IMOs. What makes humans robust in their estimation of heading or path using optic flow? We derive analytical models of optic flow for linear and curvilinear self-motion using geometric scene models. Heading biases of a linear least squares method, which builds upon these analytical models, are large, larger than those reported for humans. This motivated us to study segmentation cues that are available from optic flow. We derive models of accretion/deletion, expansion/contraction, acceleration/deceleration, local spatial curvature, and local temporal curvature, to be used as cues to segment an IMO from the background. Integrating these segmentation cues into our method of estimating heading or path now explains human psychophysical data and extends, as well as unifies, previous investigations. Our analysis suggests that various cues available from optic flow help to segment IMOs and, thus, make humans' heading and path perception robust in the presence of such IMOs. PMID:23554589

  10. Updates on bisphosphonates and potential pathobiology of bisphosphonate-induced jaw osteonecrosis.

    PubMed

    Sarin, J; DeRossi, S S; Akintoye, S O

    2008-04-01

    Osteonecrosis of the jaws is a major complication associated with long-term use of bisphosphonates. While osteonecrosis can arise from other precipitating conditions, bisphosphonate-induced jaw osteonecrosis (BJON) is highly associated with long-term administration of pamidronate (Aredia) and zoledronic acid (Zometa), which are two intravenous bisphosphonate formulations. The underlying pathogenesis of BJON and its site-specific presentation still remain to be fully elucidated. This review will discuss clinically available bisphosphonates, current opinions, pathogenesis, and management guidelines for bisphosphonate-induced jaw osteonecrosis. PMID:18336375

  11. Double-stranded DNA organization in bacteriophage heads: An alternative toroid-based model

    SciTech Connect

    Hud, N.V.

    1995-10-01

    Studies of the organization of double-stranded DNA within bacteriophage heads during the past four decades have produced a wealth of data. However, despite the presentation of numerous models, the true organization of DNA within phage heads remains unresolved. The observations of toroidal DNA structures in electron micrographs of phage lysates have long been cited as support for the organization of DNA in a spool-like fashion. This particular model, like all other models, has not been found to be consistent with all available data. Recently, the authors proposed that DNA within toroidal condensates produced in vitro is organized in a manner significantly different from that suggested by the spool model. This new toroid model has allowed the development of an alternative model for DNA organization within bacteriophage heads that is consistent with a wide range of biophysical data. Here the authors propose that bacteriophage DNA is packaged in a toroid that is folded into a highly compact structure.

  12. Simulations of a lattice model of two-headed linear amphiphiles: Influence of amphiphile asymmetry

    NASA Astrophysics Data System (ADS)

    Jackson, Douglas R.; Mohareb, Amir; MacNeil, Jennifer; Razul, M. Shajahan G.; Marangoni, D. Gerrard; Poole, Peter H.

    2011-05-01

    Using a 2D lattice model, we conduct Monte Carlo simulations of micellar aggregation of linear-chain amphiphiles having two solvophilic head groups. In the context of this simple model, we quantify how the amphiphile architecture influences the critical micelle concentration (CMC), with a particular focus on the role of the asymmetry of the amphiphile structure. Accordingly, we study all possible arrangements of the head groups along amphiphile chains of fixed length N = 12 and 16 molecular units. This set of idealized amphiphile architectures approximates many cases of symmetric and asymmetric gemini surfactants, double-headed surfactants, and boloform surfactants. Consistent with earlier results, we find that the number of spacer units s separating the heads has a significant influence on the CMC, with the CMC increasing with s for s < N/2. In comparison, the influence of the asymmetry of the chain architecture on the CMC is much weaker, as is also found experimentally.

  13. OPG-Fc but Not Zoledronic Acid Discontinuation Reverses Osteonecrosis of the Jaws (ONJ) in Mice.

    PubMed

    de Molon, Rafael Scaf; Shimamoto, Hiroaki; Bezouglaia, Olga; Pirih, Flavia Q; Dry, Sarah M; Kostenuik, Paul; Boyce, Rogely W; Dwyer, Denise; Aghaloo, Tara L; Tetradis, Sotirios

    2015-09-01

    Osteonecrosis of the jaws (ONJ) is a significant complication of antiresorptive medications, such as bisphosphonates and denosumab. Antiresorptive discontinuation to promote healing of ONJ lesions remains highly controversial and understudied. Here, we investigated whether antiresorptive discontinuation alters ONJ features in mice, employing the potent bisphosphonate zoledronic acid (ZA) or the receptor activator of NF-κB ligand (RANKL) inhibitor OPG-Fc, utilizing previously published ONJ animal models. Mice were treated with vehicle (veh), ZA, or OPG-Fc for 11 weeks to induce ONJ, and antiresorptives were discontinued for 6 or 10 weeks. Maxillae and mandibles were examined by μCT imaging and histologically. ONJ features in ZA and OPG-Fc groups included periosteal bone deposition, empty osteocyte lacunae, osteonecrotic areas, and bone exposure, each of which substantially resolved 10 weeks after discontinuing OPG-Fc but not ZA. Full recovery of tartrate-resistant acid phosphatase-positive (TRAP+) osteoclast numbers occurred after discontinuing OPG-Fc but not ZA. Our data provide the first experimental evidence demonstrating that discontinuation of a RANKL inhibitor, but not a bisphosphonate, reverses features of osteonecrosis in mice. It remains unclear whether antiresorptive discontinuation increases the risk of skeletal-related events in patients with bone metastases or fracture risk in osteoporosis patients, but these preclinical data may nonetheless help to inform discussions on the rationale for a "drug holiday" in managing the ONJ patient. PMID:25727550

  14. OPG-Fc but Not Zoledronic Acid Discontinuation Reverses Osteonecrosis of the Jaws (ONJ) in Mice

    PubMed Central

    de Molon, Rafael Scaf; Shimamoto, Hiroaki; Bezouglaia, Olga; Pirih, Flavia Q; Dry, Sarah M; Kostenuik, Paul; Boyce, Rogely W; Dwyer, Denise; Aghaloo, Tara L; Tetradis, Sotirios

    2016-01-01

    Osteonecrosis of the jaws (ONJ) is a significant complication of antiresorptive medications, such as bisphosphonates and denosumab. Antiresorptive discontinuation to promote healing of ONJ lesions remains highly controversial and understudied. Here, we investigated whether antiresorptive discontinuation alters ONJ features in mice, employing the potent bisphosphonate zoledronic acid (ZA) or the receptor activator of NF-κB ligand (RANKL) inhibitor OPG-Fc, utilizing previously published ONJ animal models. Mice were treated with vehicle (veh), ZA, or OPG-Fc for 11 weeks to induce ONJ, and antiresorptives were discontinued for 6 or 10 weeks. Maxillae and mandibles were examined by µCT imaging and histologically. ONJ features in ZA and OPG-Fc groups included periosteal bone deposition, empty osteocyte lacunae, osteonecrotic areas, and bone exposure, each of which substantially resolved 10 weeks after discontinuing OPG-Fc but not ZA. Full recovery of tartrate-resistant acid phosphatase-positive (TRAP+) osteoclast numbers occurred after discontinuing OPG-Fc but not ZA. Our data provide the first experimental evidence demonstrating that discontinuation of a RANKL inhibitor, but not a bisphosphonate, reverses features of osteonecrosis in mice. It remains unclear whether antiresorptive discontinuation increases the risk of skeletal-related events in patients with bone metastases or fracture risk in osteoporosis patients, but these preclinical data may nonetheless help to inform discussions on the rationale for a “drug holiday” in managing the ONJ patient. PMID:25727550

  15. Experimental Test of Spatial Updating Models for Monkey Eye-Head Gaze Shifts

    PubMed Central

    Van Grootel, Tom J.; Van der Willigen, Robert F.; Van Opstal, A. John

    2012-01-01

    How the brain maintains an accurate and stable representation of visual target locations despite the occurrence of saccadic gaze shifts is a classical problem in oculomotor research. Here we test and dissociate the predictions of different conceptual models for head-unrestrained gaze-localization behavior of macaque monkeys. We adopted the double-step paradigm with rapid eye-head gaze shifts to measure localization accuracy in response to flashed visual stimuli in darkness. We presented the second target flash either before (static), or during (dynamic) the first gaze displacement. In the dynamic case the brief visual flash induced a small retinal streak of up to about 20 deg at an unpredictable moment and retinal location during the eye-head gaze shift, which provides serious challenges for the gaze-control system. However, for both stimulus conditions, monkeys localized the flashed targets with accurate gaze shifts, which rules out several models of visuomotor control. First, these findings exclude the possibility that gaze-shift programming relies on retinal inputs only. Instead, they support the notion that accurate eye-head motor feedback updates the gaze-saccade coordinates. Second, in dynamic trials the visuomotor system cannot rely on the coordinates of the planned first eye-head saccade either, which rules out remapping on the basis of a predictive corollary gaze-displacement signal. Finally, because gaze-related head movements were also goal-directed, requiring continuous access to eye-in-head position, we propose that our results best support a dynamic feedback scheme for spatial updating in which visuomotor control incorporates accurate signals about instantaneous eye- and head positions rather than relative eye- and head displacements. PMID:23118883

  16. Skull Defects in Finite Element Head Models for Source Reconstruction from Magnetoencephalography Signals

    PubMed Central

    Lau, Stephan; Güllmar, Daniel; Flemming, Lars; Grayden, David B.; Cook, Mark J.; Wolters, Carsten H.; Haueisen, Jens

    2016-01-01

    Magnetoencephalography (MEG) signals are influenced by skull defects. However, there is a lack of evidence of this influence during source reconstruction. Our objectives are to characterize errors in source reconstruction from MEG signals due to ignoring skull defects and to assess the ability of an exact finite element head model to eliminate such errors. A detailed finite element model of the head of a rabbit used in a physical experiment was constructed from magnetic resonance and co-registered computer tomography imaging that differentiated nine tissue types. Sources of the MEG measurements above intact skull and above skull defects respectively were reconstructed using a finite element model with the intact skull and one incorporating the skull defects. The forward simulation of the MEG signals reproduced the experimentally observed characteristic magnitude and topography changes due to skull defects. Sources reconstructed from measured MEG signals above intact skull matched the known physical locations and orientations. Ignoring skull defects in the head model during reconstruction displaced sources under a skull defect away from that defect. Sources next to a defect were reoriented. When skull defects, with their physical conductivity, were incorporated in the head model, the location and orientation errors were mostly eliminated. The conductivity of the skull defect material non-uniformly modulated the influence on MEG signals. We propose concrete guidelines for taking into account conducting skull defects during MEG coil placement and modeling. Exact finite element head models can improve localization of brain function, specifically after surgery. PMID:27092044

  17. Proposed modification of the Huxley-Simmons model for myosin head motion along an actin filament.

    PubMed

    Mitsui, T; Chiba, H

    1996-09-21

    A model is proposed for myosin head motion along an actin filament which accommodates recent experimental data. The model includes three attached states of a myosin head and is thus similar to the classical Huxley & Simmons (1971) model, but differs in that an explicit expression is given for the spatial distribution of potential energy wells for the myosin head. Our model also differs from the classical model, in that it assumes that the proportion of myosin heads attached to actin filament is constant and independent of shortening velocity, as suggested by X-ray diffraction data. Furthermore, it posits that the crossbridge is string-like rather than spring-like. This modified model fits well to the experimental data in the following respects. (1) The calculated tension dependence of muscle stiffness agrees with the observation by Ford et al. (1985 J. Physiol. 361, 131-150). (2) A myosin head under low load can move as far as 60 nm along an actin filament during one ATP hydrolysis cycle in muscle, in agreement with the results by Yanagida et al. (1985 Nature 316, 366-369) and others. (3) The model predicts that such movements consist of a series of elementary steps of 11 nm. (4) A single myosin head hardly moves after the first step of 11 nm under the condition of in vitro experiment carried out by Finer et al. (1994 Nature 368, 113-119), in agreement with their observation. (5) The calculated energy liberation rate reproduces the characteristics of Hill's equation. (6) The "double-hyperbolic force-velocity relation" reported by Edman (1988 J. Physiol. 404, 301-321) can be understood in terms of a potential barrier against movement of a potential well in which a myosin head is trapped. PMID:8944146

  18. Immunocompromised and immunocompetent mouse models for head and neck squamous cell carcinoma

    PubMed Central

    Lei, Zhen-ge; Ren, Xiao-hua; Wang, Sha-sha; Liang, Xin-hua; Tang, Ya-ling

    2016-01-01

    Mouse models can closely mimic human oral squamous epithelial carcinogenesis, greatly expand the in vivo research possibilities, and play a critical role in the development of diagnosis, monitoring, and treatment of head and neck squamous cell carcinoma. With the development of the recent research on the contribution of immunity/inflammation to cancer initiation and progression, mouse models have been divided into two categories, namely, immunocompromised and immunocompetent mouse models. And thus, this paper will review these two kinds of models applied in head and neck squamous cell carcinoma to provide a platform to understand the complicated histological, molecular, and genetic changes of oral squamous epithelial tumorigenesis. PMID:26869799

  19. Mental Models: Knowledge in the Head and Knowledge in the World.

    ERIC Educational Resources Information Center

    Jonassen, David H.; Henning, Philip

    1999-01-01

    Explores the utility of mental models as learning outcomes in using complex and situated learning environments. Describes two studies: one aimed at eliciting mental models in the heads of novice refrigeration technicians, and the other an ethnographic study eliciting knowledge and models within the community of experienced refrigeration…

  20. Parametric Comparisons of Intracranial Mechanical Responses from Three Validated Finite Element Models of the Human Head

    PubMed Central

    Ji, Songbai; Ghadyani, Hamidreza; Bolander, Richard P.; Beckwith, Jonathan G.; Ford, James C.; Mcallister, Thomas W.; Flashman, Laura A.; Paulsen, Keith D.; Ernstrom, Karin; Jain, Sonia; Raman, Rema; Zhang, Liying; Greenwald, Richard M.

    2015-01-01

    A number of human head finite element (FE) models have been developed from different research groups over the years to study the mechanisms of traumatic brain injury. These models can vary substantially in model features and parameters, making it important to evaluate whether simulation results from one model are readily comparable with another, and whether response-based injury thresholds established from a specific model can be generalized when a different model is employed. The purpose of this study is to parametrically compare regional brain mechanical responses from three validated head FE models to test the hypothesis that regional brain responses are dependent on the specific head model employed as well as the region of interest (ROI). The Dartmouth Scaled and Normalized Model (DSNM), the Simulated Injury Monitor (SIMon), and the Wayne State University Head Injury Model (WSUHIM) were selected for comparisons. For model input, 144 unique kinematic conditions were created to represent the range of head impacts sustained by male collegiate hockey players during play. These impacts encompass the 50th, 95th, and 99th percentile peak linear and rotational accelerations at 16 impact locations around the head. Five mechanical variables (strain, strain rate, strain × strain rate, stress, and pressure) in seven ROIs reported from the FE models were compared using Generalized Estimating Equation statistical models. Highly significant differences existed among FE models for nearly all output variables and ROIs. The WSUHIM produced substantially higher peak values for almost all output variables regardless of the ROI compared to the DSNM and SIMon models (p < 0.05). DSNM also produced significantly different stress and pressure compared with SIMon for all ROIs (p < 0.05), but such differences were not consistent across ROIs for other variables. Regardless of FE model, most output variables were highly correlated with linear and rotational peak accelerations. The

  1. S-values calculated from a tomographic head/brain model for brain imaging

    NASA Astrophysics Data System (ADS)

    Chao, Tsi-chian; Xu, X. George

    2004-11-01

    A tomographic head/brain model was developed from the Visible Human images and used to calculate S-values for brain imaging procedures. This model contains 15 segmented sub-regions including caudate nucleus, cerebellum, cerebral cortex, cerebral white matter, corpus callosum, eyes, lateral ventricles, lenses, lentiform nucleus, optic chiasma, optic nerve, pons and middle cerebellar peduncle, skull CSF, thalamus and thyroid. S-values for C-11, O-15, F-18, Tc-99m and I-123 have been calculated using this model and a Monte Carlo code, EGS4. Comparison of the calculated S-values with those calculated from the MIRD (1999) stylized head/brain model shows significant differences. In many cases, the stylized head/brain model resulted in smaller S-values (as much as 88%), suggesting that the doses to a specific patient similar to the Visible Man could have been underestimated using the existing clinical dosimetry.

  2. Development of a computational biomechanical infant model for the investigation of infant head injury by shaking.

    PubMed

    Jones, Michael David; Martin, Philip S; Williams, Jonathan M; Kemp, Alison M; Theobald, Peter

    2015-10-01

    The inertial loading thresholds for infant head injury are of profound medico-legal and safety-engineering significance. Injurious experimentation with infants is impossible, and physical and computational biomechanical modelling has been frustrated by a paucity of paediatric biomechanical data. This study describes the development of a computational infant model (MD Adams®) by combining radiological, kinematic, mechanical modelling and literature-based data. Previous studies have suggested the neck as critical in determining inertial head loading. The biomechanical effects of varying neck stiffness parameters during simulated shakes were investigated, measuring peak translational and rotational accelerations and rotational velocities at the vertex. A neck quasi-static stiffness of 0.6 Nm/deg and lowest rate-dependent stiffness predisposed the model infant head to the highest accelerations. Plotted against scaled infant injury tolerance curves, simulations produced head accelerations commensurate with those produced during simulated physical model shaking reported in the literature. The model provides a computational platform for the exploitation of improvements in head biofidelity for investigating a wider range of injurious scenarios. PMID:25550310

  3. Emulating the Visual Receptive Field Properties of MST Neurons with a Template Model of Heading Estimation

    NASA Technical Reports Server (NTRS)

    Perrone, John A.; Stone, Leland S.

    1997-01-01

    We have previously proposed a computational neural-network model by which the complex patterns of retinal image motion generated during locomotion (optic flow) can be processed by specialized detectors acting as templates for specific instances of self-motion. The detectors in this template model respond to global optic flow by sampling image motion over a large portion of the visual field through networks of local motion sensors with properties similar to neurons found in the middle temporal (MT) area of primate extrastriate visual cortex. The model detectors were designed to extract self-translation (heading), self-rotation, as well as the scene layout (relative distances) ahead of a moving observer, and are arranged in cortical-like heading maps to perform this function. Heading estimation from optic flow has been postulated by some to be implemented within the medial superior temporal (MST) area. Others have questioned whether MST neurons can fulfill this role because some of their receptive-field properties appear inconsistent with a role in heading estimation. To resolve this issue, we systematically compared MST single-unit responses with the outputs of model detectors under matched stimulus conditions. We found that the basic physiological properties of MST neurons can be explained by the template model. We conclude that MST neurons are well suited to support heading estimation and that the template model provides an explicit set of testable hypotheses which can guide future exploration of MST and adjacent areas within the primate superior temporal sulcus.

  4. Model of head-neck joint fast movements in the frontal plane.

    PubMed

    Pedrocchi, A; Ferrigno, G

    2004-06-01

    The objective of this work is to develop a model representing the physiological systems driving fast head movements in frontal plane. All the contributions occurring mechanically in the head movement are considered: damping, stiffness, physiological limit of range of motion, gravitational field, and muscular torques due to voluntary activation as well as to stretch reflex depending on fusal afferences. Model parameters are partly derived from the literature, when possible, whereas undetermined block parameters are determined by optimising the model output, fitting to real kinematics data acquired by a motion capture system in specific experimental set-ups. The optimisation for parameter identification is performed by genetic algorithms. Results show that the model represents very well fast head movements in the whole range of inclination in the frontal plane. Such a model could be proposed as a tool for transforming kinematics data on head movements in 'neural equivalent data', especially for assessing head control disease and properly planning the rehabilitation process. In addition, the use of genetic algorithms seems to fit well the problem of parameter identification, allowing for the use of a very simple experimental set-up and granting model robustness. PMID:15316785

  5. Head model and electrical source imaging: A study of 38 epileptic patients☆

    PubMed Central

    Birot, Gwénael; Spinelli, Laurent; Vulliémoz, Serge; Mégevand, Pierre; Brunet, Denis; Seeck, Margitta; Michel, Christoph M.

    2014-01-01

    Electrical source imaging (ESI) aims at reconstructing the electrical brain activity from scalp EEG. When applied to interictal epileptiform discharges (IEDs), this technique is of great use for identifying the irritative zone in focal epilepsies. Inaccuracies in the modeling of electro-magnetic field propagation in the head (forward model) may strongly influence ESI and lead to mislocalization of IED generators. However, a systematic study on the influence of the selected head model on the localization precision of IED in a large number of patients with known focus localization has not yet been performed. We here present such a performance evaluation of different head models in a dataset of 38 epileptic patients who have undergone high-density scalp EEG, intracranial EEG and, for the majority, subsequent surgery. We compared ESI accuracy resulting from three head models: a Locally Spherical Model with Anatomical Constraints (LSMAC), a Boundary Element Model (BEM) and a Finite Element Model (FEM). All of them were computed from the individual MRI of the patient and ESI was performed on averaged IED. We found that all head models provided very similar source locations. In patients having a positive post-operative outcome, at least 74% of the source maxima were within the resection. The median distance from the source maximum to the nearest intracranial electrode showing IED was 13.2, 15.6 and 15.6 mm for LSMAC, BEM and FEM, respectively. The study demonstrates that in clinical applications, the use of highly sophisticated and difficult to implement head models is not a crucial factor for an accurate ESI. PMID:25003030

  6. A dynamical model for reflex activated head movements in the horizontal plane

    NASA Technical Reports Server (NTRS)

    Peng, G. C.; Hain, T. C.; Peterson, B. W.

    1996-01-01

    We present a controls systems model of horizontal-plane head movements during perturbations of the trunk, which for the first time interfaces a model of the human head with neural feedback controllers representing the vestibulocollic (VCR) and the cervicocollic (CCR) reflexes. This model is homeomorphic such that model structure and parameters are drawn directly from anthropomorphic, biomechanical and physiological studies. Using control theory we analyzed the system model in the time and frequency domains, simulating neck movement responses to input perturbations of the trunk. Without reflex control, the head and neck system produced a second-order underdamped response with a 5.2 dB resonant peak at 2.1 Hz. Adding the CCR component to the system dampened the response by approximately 7%. Adding the VCR component dampened head oscillations by 75%. The VCR also improved low-frequency compensation by increasing the gain and phase lag, creating a phase minimum at 0.1 Hz and a phase peak at 1.1 Hz. Combining all three components (mechanics, VCR and CCR) linearly in the head and neck system reduced the amplitude of the resonant peak to 1.1 dB and increased the resonant frequency to 2.9 Hz. The closed loop results closely fit human data, and explain quantitatively the characteristic phase peak often observed.

  7. Development of Head Injury Assessment Reference Values Based on NASA Injury Modeling

    NASA Technical Reports Server (NTRS)

    Somers, Jeffrey T.; Melvin, John W.; Tabiei, Ala; Lawrence, Charles; Ploutz-Snyder, Robert; Granderson, Bradley; Feiveson, Alan; Gernhardt, Michael; Patalak, John

    2011-01-01

    NASA is developing a new capsule-based, crewed vehicle that will land in the ocean, and the space agency desires to reduce the risk of injury from impact during these landings. Because landing impact occurs for each flight and the crew might need to perform egress tasks, current injury assessment reference values (IARV) were deemed insufficient. Because NASCAR occupant restraint systems are more effective than the systems used to determine the current IARVs and are similar to NASA s proposed restraint system, an analysis of NASCAR impacts was performed to develop new IARVs that may be more relevant to NASA s context of vehicle landing operations. Head IARVs associated with race car impacts were investigated by completing a detailed analysis of all of the 2002-2008 NASCAR impact data. Specific inclusion and exclusion criteria were used to select 4071 impacts from the 4015 recorder files provided (each file could contain multiple impact events). Of the 4071 accepted impacts, 274 were selected for numerical simulation using a custom NASCAR restraint system and Humanetics Hybrid-III 50th percentile numerical dummy model in LS-DYNA. Injury had occurred in 32 of the 274 selected impacts, and 27 of those injuries involved the head. A majority of the head injuries were mild concussions with or without brief loss of consciousness. The 242 non-injury impacts were randomly selected and representative of the range of crash dynamics present in the total set of 4071 impacts. Head dynamics data (head translational acceleration, translational change in velocity, rotational acceleration, rotational velocity, HIC-15, HIC-36, and the Head 3ms clip) were filtered according to SAE J211 specifications and then transformed to a log scale. The probability of head injury was estimated using a separate logistic regression analysis for each log-transformed predictor candidate. Using the log transformation constrains the estimated probability of injury to become negligible as IARVs approach

  8. Progressive Diffuse Osteonecrosis in a Patient with Secondary Hemophagocytic Lymphohistiocytosis

    PubMed Central

    Takahashi, Takashi; Rykken, Jeffrey

    2015-01-01

    This is a case report with serial imaging showing progression of diffuse osteonecrosis in a patient after a diagnosis of secondary hemophagocytic lymphohistiocytosis (HLH). While bone marrow involvement in HLH has been long noted at histological evaluation and is itself one of the diagnosis criteria, to the best of our knowledge, there has been no previous publication addressing osseous image findings in a patient with HLH. PMID:26693376

  9. Bisphosphonate-Related Osteonecrosis of the Jaw After Tooth Extraction.

    PubMed

    Ribeiro, Ney Robson Bezerra; Silva, Leonardo de Freitas; Santana, Diego Matos; Nogueira, Renato Luiz Maia

    2015-10-01

    Bisphosphonates are widely used for treatment or prevention of bone diseases characterized by high osteoclastic activity. Among the oral medicines used to treat osteoporosis, alendronate has been often used. Despite of the low rate of complications on its use, cases of osteonecrosis of the jaw have been reported on literature after tooth extractions. The main symptoms include pain, tooth mobility, swelling, erythema, and ulceration. The risk factors related to osteonecrosis of the jaw associated with bisphosphonate are exposition time to the medicine, routes of administration, and oral surgical procedures performed. The aim of this work is to report a case of a patient showing osteonecrosis of the jaw associated with the use of oral bisphosphonates after tooth extractions. The patient was treated through the suspension of the alendronate with the removal of the necrotic tissue and the foci of infection. After a year's follow-up, the patient showed no recurrence signs. From the foregoing, the interruption of the alendronate use and the surgical treatment associated to antibiotic therapy showed effective on the patient's treatment. PMID:26468839

  10. Pain Prevention Using Head and Neck Cancer as a Model

    PubMed Central

    McMenamin, Erin M.; Grant, Marcia

    2015-01-01

    Pain is a common and often debilitating consequence of cancer and its treatment. Efforts to improve pain management for patients diagnosed with cancer have not resulted in widespread patient reports of acceptable management of pain. Patients and providers alike remain opiophobic due to a number of issues, resulting in suboptimal management of pain. Recent literature has revealed that it may be possible to prevent pain related to cancer and its treatment and therefore avoid or decrease the amount of opioids used to treat pain. This may result in better quality of life for patients. Several newer antiepileptic drugs (AEDs) have been found to decrease the perception of pain in a number of patient populations, including those with head and neck cancer. The side-effect profile for the newer AEDs is mild and well tolerated. Future efforts should focus on the use of newer AEDs to prevent pain in other cancer populations, with a focus on ideal dose and scheduling. Once established, recommendations regarding the prevention of pain in patients with cancer can be incorporated into national guidelines. PMID:26413373

  11. Five-layer realistic head model based on inhomogeneous and anisotropic conductivity distribution of different tissues

    NASA Astrophysics Data System (ADS)

    Yan, Dandan; Zhang, Jianwei; Wu, Weijuan; Ying, Xiaoyan; Wu, Xiangping

    2009-10-01

    This paper is focused on the sophisticated realistic head modeling based on inhomogeneous and anisotropic conductivity distribution of the head tissues. The finite element method (FEM) was used to model the five-layer head volume conductor models with hexahedral elements from segmentation and mapping of DT-MRI data. Then the inhomogeneous conductivities of the scalp, CSF and gray matter tissue were distributed according a normal distribution based on the mean value of respective tissues. The electric conductivity of the brain tissues dictates different inhomogeneous and anisotropic at some different microscopic levels. Including the inhomogeneous and anisotropy of the tissue would improve the accuracy of the MREIT, EEG and MEG problems in the simulation research.

  12. Dynamic modeling of the neck muscles during horizontal head movement.

    PubMed

    Haapala, Stephenie A; Enderle, John D

    2002-01-01

    This paper presents modeling and simulation of superficial neck muscle movement in the horizontal plane (yaw). The parametric muscle model was constructed using Pro/Engineer 2000i Student Edition, Parametric Technologies Corp, and simulated using Pro/Mechanica. Pennation angles, force-tension, force-generation and rate of muscle activation data were obtained from anatomic and physiological studies. Saccadic eye movement models developed by G. Alexander Korentis and John Enderle also provided the basis for this model. PMID:12085608

  13. Of lice and math: using models to understand and control populations of head lice.

    PubMed

    Laguna, María Fabiana; Laguna, Mara Fabiana; Risau-Gusman, Sebastián

    2011-01-01

    In this paper we use detailed data about the biology of the head louse (pediculus humanus capitis) to build a model of the evolution of head lice colonies. Using theory and computer simulations, we show that the model can be used to assess the impact of the various strategies usually applied to eradicate head lice, both conscious (treatments) and unconscious (grooming). In the case of treatments, we study the difference in performance that arises when they are applied in systematic and non-systematic ways. Using some reasonable simplifying assumptions (as random mixing of human groups and the same mobility for all life stages of head lice other than eggs) we model the contagion of pediculosis using only one additional parameter. It is shown that this parameter can be tuned to obtain collective infestations whose characteristics are compatible with what is given in the literature on real infestations. We analyze two scenarios: One where group members begin treatment when a similar number of lice are present in each head, and another where there is one individual who starts treatment with a much larger threshold ("superspreader"). For both cases we assess the impact of several collective strategies of treatment. PMID:21799752

  14. Of Lice and Math: Using Models to Understand and Control Populations of Head Lice

    PubMed Central

    Laguna, Mara Fabiana; Risau-Gusman, Sebastián

    2011-01-01

    In this paper we use detailed data about the biology of the head louse (pediculus humanus capitis) to build a model of the evolution of head lice colonies. Using theory and computer simulations, we show that the model can be used to assess the impact of the various strategies usually applied to eradicate head lice, both conscious (treatments) and unconscious (grooming). In the case of treatments, we study the difference in performance that arises when they are applied in systematic and non-systematic ways. Using some reasonable simplifying assumptions (as random mixing of human groups and the same mobility for all life stages of head lice other than eggs) we model the contagion of pediculosis using only one additional parameter. It is shown that this parameter can be tuned to obtain collective infestations whose characteristics are compatible with what is given in the literature on real infestations. We analyze two scenarios: One where group members begin treatment when a similar number of lice are present in each head, and another where there is one individual who starts treatment with a much larger threshold (“superspreader”). For both cases we assess the impact of several collective strategies of treatment. PMID:21799752

  15. Bisphosphonate-related osteonecrosis of the jaws: Report of a case using conservative protocol.

    PubMed

    Heggendorn, Fabiano Luiz; Leite, Taiana Campos; Cunha, Karin Soares Gonçalves; Junior, Arley Silva; Gonçalves, Lucio Souza; da Costa, Karla Bianca Fernandes Fontes; Dias, Eliane Pedra

    2016-01-01

    Bisphosphonates have been the first-line treatment option for osteometabolic diseases, such as osteoporosis, hypercalcaemia in malignant bone diseases, and in bone metastasis. It is possible to observe a growing number of cases of osteonecrosis of the jaws in patients using this medication, called bisphosphonate-related osteonecrosis of the jaws. The purpose of this study was to report a conservative treatment for bisphosphonate-related osteonecrosis of the jaws--Stage 2, using antibacterial solution and low-level laser therapy. At the end of the treatment, the patient presented improvement of the lesion with the healing of the mucosa. The literature still lacks successful definite protocols, thus the present case may contribute with another option for conservative management for bisphosphonate-related osteonecrosis of the jaws. More research is necessary in order to develop a good protocol management for bisphosphonate-related osteonecrosis of the jaws. PMID:26782365

  16. Mechanism of head and neck response to -Gx impact acceleration: a math modeling approach.

    PubMed

    Frisch, G D; D'Aulerio, L; O'Rourke, J

    1977-03-01

    Mathematical modeling has attained wider acceptance in recent years. In particular, the use of computer programs to simulate the dynamic response of a human in a crash situation has become an attractive alternative to full-scale experimental testing. This paper analyzes data on the dynamic response of the living human head and neck to -Gx impact acceleration, where the motion of the subject's head and neck in the midsagittal plane was monitored with inertial instrumentation and high-speed photography for confirmation. The Calspan "3D Computer Simulator of Motor Vehicle Crash Victims" was used to predict expected responses for the deceleration pulses employed. These estimates were compared to the fully instrumented human test runs. The standard 15-segment and 14-joint representation of the occupant was modified to include two sternoclavicular joints, increasing the articulation in the upper torso. Analysis of the data indicated that muscular activity in the head and neck seemed to be evident and does influence motion of the head, even at relatively high (10-G peak, 530 G/s onset) acceleration levels. Simulation of muscular contraction, using a spring-damper arrangement, improved the results significantly. Additionally, possible limitations to head-to-neck motion, such as ligament restrictions, were also modeled. PMID:856153

  17. SCDAP/RELAP5 Modeling of Heat Transfer and Flow Losses in Lower Head Porous Debris

    SciTech Connect

    E. W. Coryell; L. J. Siefken; S. Paik

    1998-09-01

    Designs are described for implementing models for calculating the heat transfer and flow losses in porous debris in the lower head of a reactor vessel. The COUPLE model in SCDAP/RELAP5 represents both the porous and nonporous debris that results from core material slumping into the lower head. Currently, the COUPLE model has the capability to model convective and radiative heat transfer from the surfaces of nonporous debris in a detailed manner and to model only in a simplistic manner the heat transfer from porous debris. In order to advance beyond the simplistic modeling for porous debris, designs are developed for detailed calculations of heat transfer and flow losses in porous debris. Correlations are identified for convective heat transfer in porous debris for the following modes of heat transfer; (1) forced convection to liquid, (2) forced convection to gas, (3) nucleate boiling, (4) transition boiling, and (5) film boiling. Interphase heat transfer is modeled in an approximate manner. A design is also described for implementing a model of heat transfer by radiation from debris to the interstitial fluid. A design is described for implementation of models for flow losses and interphase drag in porous debris. Since the models for heat transfer and flow losses in porous debris in the lower head are designed for general application, a design is also described for implementation of these models to the analysis of porous debris in the core region. A test matrix is proposed for assessing the capability of the implemented models to calculate the heat transfer and flow losses in porous debris. The implementation of the models described in this report is expected to improve the COUPLE code calculation of the temperature distribution in porous debris and in the lower head that supports the debris. The implementation of these models is also expected to improve the calculation of the temperature and flow distribution in porous debris in the core region.

  18. Accessible and informative sectioned images and surface models of a cadaver head.

    PubMed

    Shin, Dong Sun; Jang, Hae Gwon; Park, Jin Seo; Park, Hyung Seon; Lee, Sangho; Chung, Min Suk

    2012-07-01

    The sectioned images and surface models of a cadaver head in the Visible Korean Project would be more beneficial if they were accessible and informative. To this aim, 3 policies were established: (1) the data are promptly obtainable and observable; (2) the graphic data are accompanied by explaining the anatomic terms; and (3) two-dimensional images and three-dimensional models are shown together. According to the policies, the following were attempted. Two hundred thirty-five couples of sectioned images and outlined images (intervals, 1 mm) of the head were prepared. Browsing software was developed where the 2 corresponding images were displayed simultaneously. In addition, the structures in the images were recognized with the aid of automatic labeling. From the outlined images, surface models of 178 head structures were constructed. The two-dimensional surface models including the sectioned images were embedded into the three-dimensional surface models. All the models were categorized into systems and arranged to be inputted to a PDF (portable document format) file. The finalized PDF file containing comprehensive head data could be explored on Adobe Reader. If the user clicked on the surface models, their anatomic names were highlighted. The sectioned images, outlined images, and surface models in the browsing software and PDF file can be downloaded from the homepage (anatomy.co.kr) free of charge. The state-of-the-art graphic information will hopefully assist medical students in learning head anatomy. In addition, the raw data are expected to contribute to the various clinical practice simulations. PMID:22801119

  19. A Porcine Model of Traumatic Brain Injury via Head Rotational Acceleration.

    PubMed

    Cullen, D Kacy; Harris, James P; Browne, Kevin D; Wolf, John A; Duda, John E; Meaney, David F; Margulies, Susan S; Smith, Douglas H

    2016-01-01

    Unique from other brain disorders, traumatic brain injury (TBI) generally results from a discrete biomechanical event that induces rapid head movement. The large size and high organization of the human brain makes it particularly vulnerable to traumatic injury from rotational accelerations that can cause dynamic deformation of the brain tissue. Therefore, replicating the injury biomechanics of human TBI in animal models presents a substantial challenge, particularly with regard to addressing brain size and injury parameters. Here we present the historical development and use of a porcine model of head rotational acceleration. By scaling up the rotational forces to account for difference in brain mass between swine and humans, this model has been shown to produce the same tissue deformations and identical neuropathologies found in human TBI. The parameters of scaled rapid angular accelerations applied for the model reproduce inertial forces generated when the human head suddenly accelerates or decelerates in falls, collisions, or blunt impacts. The model uses custom-built linkage assemblies and a powerful linear actuator designed to produce purely impulsive non-impact head rotation in different angular planes at controlled rotational acceleration levels. Through a range of head rotational kinematics, this model can produce functional and neuropathological changes across the spectrum from concussion to severe TBI. Notably, however, the model is very difficult to employ, requiring a highly skilled team for medical management, biomechanics, neurological recovery, and specialized outcome measures including neuromonitoring, neurophysiology, neuroimaging, and neuropathology. Nonetheless, while challenging, this clinically relevant model has proven valuable for identifying mechanisms of acute and progressive neuropathologies as well as for the evaluation of noninvasive diagnostic techniques and potential neuroprotective treatments following TBI. PMID:27604725

  20. A dynamic factor modeling framework for analyzing multiple groundwater head series simultaneously

    NASA Astrophysics Data System (ADS)

    Berendrecht, W. L.; van Geer, F. C.

    2016-05-01

    In this paper we present an approach in which we combine a dynamic factor model (DFM) and predefined response functions to analyze a set of groundwater head series simultaneously. Each groundwater head series is decomposed into: (a) one or more deterministic components as a response to known driving forces, (b) one or more common dynamic factors, representing spatial patterns not related to any of the input series and (c) one specific dynamic factor for each groundwater head series, describing unique variation for that series. The approach reduces the degrees of freedom for each response function, enables the application to irregular observed data, and exploits the correlation between residual series of a set of groundwater head series. The common dynamic factors may be interpreted as spatial patterns due to e.g. limitations in the model specification or concept, spatially correlated errors in input variables, or driving forces which have not been included in the model. In the latter case the model can be applied in the context of an alarming system, e.g. to monitor regional trends. The specific dynamic factor depicts the variation of a particular groundwater head series that cannot be related to any other time series of the set nor to any input series. Therefore the specific dynamic factor is suitable for analyzing local variations and detecting incidental measurement errors, for example in a quality control procedure. The DFM framework is illustrated with a set of 8 groundwater head series and applied for filling gaps in time series, reconstructing high-frequency data, and detecting outliers.

  1. Development of a finite element human head model partially validated with thirty five experimental cases.

    PubMed

    Mao, Haojie; Zhang, Liying; Jiang, Binhui; Genthikatti, Vinay V; Jin, Xin; Zhu, Feng; Makwana, Rahul; Gill, Amandeep; Jandir, Gurdeep; Singh, Amrinder; Yang, King H

    2013-11-01

    This study is aimed to develop a high quality, extensively validated finite element (FE) human head model for enhanced head injury prediction and prevention. The geometry of the model was based on computed tomography (CT) and magnetic resonance imaging scans of an adult male who has the average height and weight of an American. A feature-based multiblock technique was adopted to develop hexahedral brain meshes including the cerebrum, cerebellum, brainstem, corpus callosum, ventricles, and thalamus. Conventional meshing methods were used to create the bridging veins, cerebrospinal fluid, skull, facial bones, flesh, skin, and membranes-including falx, tentorium, pia, arachnoid, and dura. The head model has 270,552 elements in total. Thirty five loading cases were selected from a range of experimental head impacts to check the robustness of the model predictions based on responses including the brain pressure, relative skull-brain motion, skull response, and facial response. The brain pressure was validated against intracranial pressure data reported by Nahum et al. (1977, "Intracranial Pressure Dynamics During Head Impact," Proc. 21st Stapp Car Crash Conference, SAE Technical Paper No. 770922) and Trosseille et al. (1992, "Development of a F.E.M. of the Human Head According to a Specific Test Protocol," Proc. 36th Stapp Car Crash Conference, SAE Technical Paper No. 922527). The brain motion was validated against brain displacements under sagittal, coronal, and horizontal blunt impacts performed by Hardy et al. (2001, "Investigation of Head Injury Mechanisms Using Neutral Density Technology and High-Speed Biplanar X-Ray," Stapp Car Crash Journal, 45, pp. 337-368; and 2007, "A Study of the Response of the Human Cadaver Head to Impact," Stapp Car Crash Journal, 51, pp. 17-80). The facial bone responses were validated under nasal impact (Nyquist et al. 1986, "Facial Impact Tolerance and Response," Proc. 30th Stapp Car Crash Conference, SAE Technical Paper No. 861896

  2. SCDAP/RELAP5 Modeling of Heat Transfer and Flow Losses in Lower Head Porous Debris

    SciTech Connect

    Siefken, Larry James; Coryell, Eric Wesley; Paik, Seungho; Kuo, Han Hsiung

    1999-07-01

    Designs are described for implementing models for calculating the heat transfer and flow losses in porous debris in the lower head of a reactor vessel. The COUPLE model in SCDAP/RELAP5 represents both the porous and nonporous debris that results from core material slumping into the lower head. Currently, the COUPLE model has the capability to model convective and radiative heat transfer from the surfaces of nonporous debris in a detailed manner and to model only in a simplistic manner the heat transfer from porous debris. In order to advance beyond the simplistic modeling for porous debris, designs are developed for detailed calculations of heat transfer and flow losses in porous debris. Correlations are identified for convective heat transfer in porous debris for the following modes of heat transfer; (1) forced convection to liquid, (2) forced convection to gas, (3) nucleate boiling, (4) transition boiling, and (5) film boiling. Interphase heat transfer is modeled in an approximate manner. Designs are described for models to calculate the flow losses and interphase drag of fluid flowing through the interstices of the porous debris, and to apply these variables in the momentum equations in the RELAP5 part of the code. Since the models for heat transfer and flow losses in porous debris in the lower head are designed for general application, a design is also described for implementation of these models to the analysis of porous debris in the core region. A test matrix is proposed for assessing the capability of the implemented models to calculate the heat transfer and flow losses in porous debris. The implementation of the models described in this report is expected to improve the COUPLE code calculation of the temperature distribution in porous debris and in the lower head that supports the debris. The implementation of these models is also expected to improve the calculation of the temperature and flow distribution in porous debris in the core region.

  3. The influence of CSF on EEG sensitivity distributions of multilayered head models.

    PubMed

    Wendel, K; Narra, N G; Hannula, M; Kauppinen, P; Malmivuo, J

    2008-04-01

    We examined how the cerebrospinal fluid (CSF) affects the distribution of electroencephalogram (EEG) measurement sensitivity. We used concentric spheres and realistic head models to investigate the difference between computed-tomography (CT) and magnetic resonance image (MRI) models that exclude the CSF layer. The cortical EEG sensitivity distributions support these phenomena and show that the CSF layer significantly influences them, thus identifying the importance of including the CSF layer inside the head volume conductor models. The results show that the highly conductive CSF channels the current, thus decreasing the maximum cortical current density relative to models that do not include the CSF. We found that the MRI and CT models yielded HSV results 20% and 45%, respectively, too small when compared with CSF-inclusive models. PMID:18390339

  4. SCDAP/RELAP5 Modeling of Movement of Melted Material Through Porous Debris in Lower Head

    SciTech Connect

    Siefken, Larry James; Harvego, Edwin Allan

    2000-04-01

    A model is described for the movement of melted metallic material through a ceramic porous debris bed. The model is designed for the analysis of severe accidents in LWRs, wherein melted core plate material may slump onto the top of a porous bed of relocated core material supported by the lower head. The permeation of the melted core plate material into the porous debris bed influences the heatup of the debris bed and the heatup of the lower head supporting the debris. A model for mass transport of melted metallic material is applied that includes terms for viscosity and turbulence but neglects inertial and capillary terms because of their small value relative to gravity and viscous terms in the momentum equation. The relative permeability and passability of the porous debris are calculated as functions of debris porosity, particle size, and effective saturation. An iterative numerical solution is used to solve the set of nonlinear equations for mass transport. The effective thermal conductivity of the debris is calculated as a function of porosity, particle size, and saturation. The model integrates the equations for mass transport with a model for the two-dimensional conduction of heat through porous debris. The integrated model has been implemented into the SCDAP/RELAP5 code for the analysis of the integrity of LWR lower heads during severe accidents. The results of the model indicate that melted core plate material may permeate to near the bottom of a 1m deep hot porous debris bed supported by the lower head. The presence of the relocated core plate material was calculated to cause a 12% increase in the heat flux on the external surface of the lower head.

  5. SCDAP/RELAP5 modeling of movement of melted material through porous debris in lower head

    SciTech Connect

    L. J. Siefken; E. A. Harvego

    2000-04-02

    A model is described for the movement of melted metallic material through a ceramic porous debris bed. The model is designed for the analysis of severe accidents in LWRs, wherein melted core plate material may slump onto the top of a porous bed of relocated core material supported by the lower head. The permeation of the melted core plate material into the porous debris bed influences the heatup of the debris bed and the heatup of the lower head supporting the debris. A model for mass transport of melted metallic material is applied that includes terms for viscosity and turbulence but neglects inertial and capillary terms because of their small value relative to gravity and viscous terms in the momentum equation. The relative permeability and passability of the porous debris are calculated as functions of debris porosity, particle size, and effective saturation. An iterative numerical solution is used to solve the set of nonlinear equations for mass transport. The effective thermal conductivity of the debris is calculated as a function of porosity, particle size, and saturation. The model integrates the equations for mass transport with a model for the two-dimensional conduction of heat through porous debris. The integrated model has been implemented into the SCDAP/RELAP5 code for the analysis of the integrity of LWR lower heads during severe accidents. The results of the model indicate that melted core plate material may permeate to near the bottom of a 1m deep hot porous debris bed supported by the lower head. The presence of the relocated core plate material was calculated to cause a 12% increase in the heat flux on the external surface of the lower head.

  6. Extracorporeal shockwave therapy for avascular necrosis of femoral head.

    PubMed

    Wang, Ching-Jen; Cheng, Jai-Hong; Huang, Chung-Cheng; Yip, Han-Kan; Russo, Sergio

    2015-12-01

    The etiology of osteonecrosis of the femoral head (ONFH) is multifactorial. Treatment of ONFH is disease stage dependent. For early stages, femoral head preservation procedures are preferred including core decompression, muscle pedicle grafting and de-rotational osteotomy. Core decompression with bone grafting is considered the gold standard. However, the results are inconsistence and unpredictable. An effective non-invasive method of treatment is imperative. Recently, extracorporeal shockwave therapy (ESWT) has shown beneficial effects in ONFH. ESWT improves pain and function of the hip and regression of the ONFH lesion. ESWT is more effective than core decompression with or without bone grafting, cocktail therapy that combined HBO, ESWT and oral alendronate is shown effective for patients with early osteonecrosis. The purpose of the article is to review, update and summarize the clinical treatment of ONFH using shockwave therapy. PMID:26188081

  7. Phytomolecule icaritin incorporated PLGA/TCP scaffold for steroid-associated osteonecrosis: Proof-of-concept for prevention of hip joint collapse in bipedal emus and mechanistic study in quadrupedal rabbits.

    PubMed

    Qin, Ling; Yao, Dong; Zheng, Lizhen; Liu, Wai-Ching; Liu, Zhong; Lei, Ming; Huang, Le; Xie, Xinhui; Wang, Xinluan; Chen, Yang; Yao, Xinsheng; Peng, Jiang; Gong, He; Griffith, James F; Huang, Yanping; Zheng, Yongping; Feng, Jian Q; Liu, Ying; Chen, Shihui; Xiao, Deming; Wang, Daping; Xiong, Jiangyi; Pei, Duanqing; Zhang, Peng; Pan, Xiaohua; Wang, Xiaohong; Lee, Kwong-Man; Cheng, Chun-Yiu

    2015-08-01

    Steroid-associated osteonecrosis (SAON) may lead to joint collapse and subsequent joint replacement. Poly lactic-co-glycolic acid/tricalcium phosphate (P/T) scaffold providing sustained release of icaritin (a metabolite of Epimedium-derived flavonoids) was investigated as a bone defect filler after surgical core-decompression (CD) to prevent femoral head collapse in a bipedal SAON animal model using emu (a large flightless bird). The underlying mechanism on SAON was evaluated using a well-established quadrupedal rabbit model. Fifteen emus were established with SAON, and CD was performed along the femoral neck for the efficacy study. In this CD bone defect, a P/T scaffold with icaritin (P/T/I group) or without icaritin (P/T group) was implanted while no scaffold implantation was used as a control. For the mechanistic study in rabbits, the effects of icaritin and composite scaffolds on bone mesenchymal stem cells (BMSCs) recruitment, osteogenesis, and anti-adipogenesis were evaluated. Our efficacy study showed that P/T/I group had the significantly lowest incidence of femoral head collapse, better preserved cartilage and mechanical properties supported by more new bone formation within the bone tunnel. For the mechanistic study, our in vitro tests suggested that icaritin enhanced the expression of osteogenesis related genes COL1α, osteocalcin, RUNX2, and BMP-2 while inhibited adipogenesis related genes C/EBP-ß, PPAR-γ, and aP2 of rabbit BMSCs. Both P/T and P/T/I scaffolds were demonstrated to recruit BMSCs both in vitro and in vivo but a higher expression of migration related gene VCAM1 was only found in P/T/I group in vitro. In conclusion, both efficacy and mechanistic studies show the potential of a bioactive composite porous P/T scaffold incorporating icaritin to enhance bone defect repair after surgical CD and prevent femoral head collapse in a bipedal SAON emu model. PMID:25968462

  8. BrainK for Structural Image Processing: Creating Electrical Models of the Human Head

    PubMed Central

    Li, Kai; Papademetris, Xenophon; Tucker, Don M.

    2016-01-01

    BrainK is a set of automated procedures for characterizing the tissues of the human head from MRI, CT, and photogrammetry images. The tissue segmentation and cortical surface extraction support the primary goal of modeling the propagation of electrical currents through head tissues with a finite difference model (FDM) or finite element model (FEM) created from the BrainK geometries. The electrical head model is necessary for accurate source localization of dense array electroencephalographic (dEEG) measures from head surface electrodes. It is also necessary for accurate targeting of cerebral structures with transcranial current injection from those surface electrodes. BrainK must achieve five major tasks: image segmentation, registration of the MRI, CT, and sensor photogrammetry images, cortical surface reconstruction, dipole tessellation of the cortical surface, and Talairach transformation. We describe the approach to each task, and we compare the accuracies for the key tasks of tissue segmentation and cortical surface extraction in relation to existing research tools (FreeSurfer, FSL, SPM, and BrainVisa). BrainK achieves good accuracy with minimal or no user intervention, it deals well with poor quality MR images and tissue abnormalities, and it provides improved computational efficiency over existing research packages. PMID:27293419

  9. BrainK for Structural Image Processing: Creating Electrical Models of the Human Head.

    PubMed

    Li, Kai; Papademetris, Xenophon; Tucker, Don M

    2016-01-01

    BrainK is a set of automated procedures for characterizing the tissues of the human head from MRI, CT, and photogrammetry images. The tissue segmentation and cortical surface extraction support the primary goal of modeling the propagation of electrical currents through head tissues with a finite difference model (FDM) or finite element model (FEM) created from the BrainK geometries. The electrical head model is necessary for accurate source localization of dense array electroencephalographic (dEEG) measures from head surface electrodes. It is also necessary for accurate targeting of cerebral structures with transcranial current injection from those surface electrodes. BrainK must achieve five major tasks: image segmentation, registration of the MRI, CT, and sensor photogrammetry images, cortical surface reconstruction, dipole tessellation of the cortical surface, and Talairach transformation. We describe the approach to each task, and we compare the accuracies for the key tasks of tissue segmentation and cortical surface extraction in relation to existing research tools (FreeSurfer, FSL, SPM, and BrainVisa). BrainK achieves good accuracy with minimal or no user intervention, it deals well with poor quality MR images and tissue abnormalities, and it provides improved computational efficiency over existing research packages. PMID:27293419

  10. A Neural Model of How the Brain Computes Heading from Optic Flow in Realistic Scenes

    ERIC Educational Resources Information Center

    Browning, N. Andrew; Grossberg, Stephen; Mingolla, Ennio

    2009-01-01

    Visually-based navigation is a key competence during spatial cognition. Animals avoid obstacles and approach goals in novel cluttered environments using optic flow to compute heading with respect to the environment. Most navigation models try either explain data, or to demonstrate navigational competence in real-world environments without regard…

  11. Earnings Profiles of Department Heads: Comparing Cross-Sectional and Panel Models.

    ERIC Educational Resources Information Center

    Ragan, James F., Jr.; Rehman, Qazi Najeeb

    1996-01-01

    A cross-sectional study of 842 faculty who served as department heads between 1965-92 was compared with 170 in a panel study for whom earnings were estimated using a personal effects model. The average chair received a 12% wage premium for administrative service. Skill depreciation was most severe and wage growth most adversely affected in the…

  12. Realistic numerical modelling of human head tissue exposure to electromagnetic waves from cellular phones

    NASA Astrophysics Data System (ADS)

    Scarella, Gilles; Clatz, Olivier; Lanteri, Stéphane; Beaume, Grégory; Oudot, Steve; Pons, Jean-Philippe; Piperno, Sergo; Joly, Patrick; Wiart, Joe

    2006-06-01

    The ever-rising diffusion of cellular phones has brought about an increased concern for the possible consequences of electromagnetic radiation on human health. Possible thermal effects have been investigated, via experimentation or simulation, by several research projects in the last decade. Concerning numerical modeling, the power absorption in a user's head is generally computed using discretized models built from clinical MRI data. The vast majority of such numerical studies have been conducted using Finite Differences Time Domain methods, although strong limitations of their accuracy are due to heterogeneity, poor definition of the detailed structures of head tissues (staircasing effects), etc. In order to propose numerical modeling using Finite Element or Discontinuous Galerkin Time Domain methods, reliable automated tools for the unstructured discretization of human heads are also needed. Results presented in this article aim at filling the gap between human head MRI images and the accurate numerical modeling of wave propagation in biological tissues and its thermal effects. To cite this article: G. Scarella et al., C. R. Physique 7 (2006).

  13. Female-Headed Families: An Ecological Model of Residential Concentration in a Small City.

    ERIC Educational Resources Information Center

    And Others; Roncek, Dennis W.

    1980-01-01

    Proposed an ecological model to explain the concentration of female-headed families in a small city. Data for city blocks provided patterns of concentration. Of the physical variables, only historical development of the city and market decisions by nonresidential consumers were important predictors of concentration; spatial concentration was not…

  14. Head and brain response to blast using sagittal and transverse finite element models.

    PubMed

    Singh, Dilaver; Cronin, Duane S; Haladuick, Tyler N

    2014-04-01

    Mild traumatic brain injury caused by blast exposure from Improvised Explosive Devices has become increasingly prevalent in modern conflicts. To investigate head kinematics and brain tissue response in blast scenarios, two solid hexahedral blast-head models were developed in the sagittal and transverse planes. The models were coupled to an Arbitrary Lagrangian-Eulerian model of the surrounding air to model blast-head interaction, for three blast load cases (5 kg C4 at 3, 3.5 and 4 m). The models were validated using experimental kinematic data, where predicted accelerations were in good agreement with experimental tests, and intracranial pressure traces at four locations in the brain, where the models provided good predictions for frontal, temporal and parietal, but underpredicted pressures at the occipital location. Brain tissue response was investigated for the wide range of constitutive properties available. The models predicted relatively low peak principal brain tissue strains from 0.035 to 0.087; however, strain rates ranged from 225 to 571 s-1. Importantly, these models have allowed us to quantify expected strains and strain rates experienced in brain tissue, which can be used to guide future material characterization. These computationally efficient and predictive models can be used to evaluate protection and mitigation strategies in future analysis. PMID:24293124

  15. A Model of Mira's Cometary Head/Tail Entering the Local Bubble

    NASA Astrophysics Data System (ADS)

    Esquivel, A.; Raga, A. C.; Cantó, J.; Rodríguez-González, A.; López-Cámara, D.; Velázquez, P. F.; De Colle, F.

    2010-12-01

    We model the cometary structure around Mira as the interaction of an asymptotic giant branch stellar wind from Mira A with a streaming environment. Our simulations introduce the following new element: we assume that after 200 kyr of evolution in a dense environment, Mira entered the Local Bubble (low-density coronal gas). As Mira enters the bubble, the head of the comet expands quite rapidly, while the tail remains well collimated for a >100 kyr timescale. The result is a broad-head/narrow-tail structure that resembles the observed morphology of Mira's comet. The simulations were carried out with our new adaptive grid code WALICXE, which is described in detail.

  16. Animal models of psychopathology: the establishment, maintenance, attenuation, and persistence of head-banging by pigeons.

    PubMed

    Layng, T V; Andronis, P T; Goldiamond, I

    1999-03-01

    Investigators of animal models of psychopathology have typically introduced experimental conditions so that an animal's behavior progressively deviates from a baseline of routine laboratory behavior toward a pattern which resembles human psychopathological behavior in some form of S, then R relation. The present experiments report consequential contingency procedures for bringing head-to-wall head-banging by an animal under experimental control and analysis. The first two experiments examined the establishment and maintenance by reinforcement of head-banging by pigeons. The final two experiments examined the occurrence of head-banging, under conditions of extinction and limited reinforcement, when an alternative behavior, i.e., key-pecking, was reinforced under a variety of reinforcement schedules. Extinguished and infrequently reinforced head-banging was found to recur under a variety of conditions including the reinforcement of the more "normal" alternative behavior. To the extent that human patterns are governed by similar functional relations, the data may be of relevance in the analysis of the maintenance, attenuation, and recurrence of human patterns designated as pathological. Further, the permanent elimination of a disturbing pattern may be difficult, and the recurrence of a disturbing pattern might properly be considered a likely and "normal" outcome of basic behavioral processes. PMID:10365865

  17. Femoral head blood flow in long-term steroid therapy: study of rabbit model.

    PubMed

    Wang, G J; Hubbard, S L; Reger, S I; Miller, E D; Stamp, W G

    1983-12-01

    Using a rabbit model, previous studies showed steroid-induced hyperlipidemia with subsequent fatty embolization of the subchondral arteries and hypertrophy of the marrow fat cells, followed by elevation of femoral head pressure from the normal level of 25 cm to nearly 60 cm H2O after eight weeks of treatment. This has led us to believe that pressure changes lead to decreased blood flow in the femoral head. In our study of 22 New Zealand white adult rabbits, weighing an average of 4.0 kg, 14 received a weekly dose of 12.45 mg of methylprednisolone (Depo-Medrol), and eight served as control. Femoral head blood flow was established using the radioactive microsphere technique. Control and cortisone-treated rabbits had femoral head blood flow measured 6, 8 and 10 weeks after treatment. The average blood flow in the control femoral heads averaged 0.2039 +/- 0.076 ml/min/gm, with no difference in the left side and the right side. In the treated group, the average blood flow at ten weeks was 0.162 +/- 0.039 ml/min/gm on the right and 0.164 +/- 0.037 ml/min/gm on the left, which was significantly different. This is parallel to unpredictable clinical findings in human beings. PMID:6648615

  18. Femoral head blood flow in long-term steroid therapy: study of rabbit model

    SciTech Connect

    Wang, G.J.; Hubbard, S.L.; Reger, S.I.; Miller, E.D.; Stamp, W.G.

    1983-12-01

    Using a rabbit model, previous studies showed steroid-induced hyperlipidemia with subsequent fatty embolization of the subchondral arteries and hypertrophy of the marrow fat cells, followed by elevation of femoral head pressure from the normal level of 25 cm to nearly 60 cm H2O after eight weeks of treatment. This has led us to believe that pressure changes lead to decreased blood flow in the femoral head. In our study of 22 New Zealand white adult rabbits, weighing an average of 4.0 kg, 14 received a weekly dose of 12.45 mg of methylprednisolone (Depo-Medrol), and eight served as control. Femoral head blood flow was established using the radioactive microsphere technique. Control and cortisone-treated rabbits had femoral head blood flow measured 6, 8 and 10 weeks after treatment. The average blood flow in the control femoral heads averaged 0.2039 +/- 0.076 ml/min/gm, with no difference in the left side and the right side. In the treated group, the average blood flow at ten weeks was 0.162 +/- 0.039 ml/min/gm on the right and 0.164 +/- 0.037 ml/min/gm on the left, which was significantly different. This is parallel to unpredictable clinical findings in human beings.

  19. Electromagnetic field generated in model of human head by simplified telephone transceiver

    NASA Astrophysics Data System (ADS)

    King, Ronold W. P.

    1995-01-01

    Possible adverse effects of electromagnetic fields on the human body and especially on the nervous system and the brain are of increasing concern, particularly with reference to cellular telephone transceivers held close to the head. An essential step in the study of this problem is the accurate determination of the complete electromagnetic field penetrating through the skull into the brain. Simple analytical formulas are derived from the theory of the horizontal electric dipole over a layered region. These give the components of the electric and magnetic fields on the air-head surface, in the skin-skull layer, and throughout the brain in terms of a planar model with the dimensions and average electrical properties of the human head. The specific absorption rate (SAR) is also determined.

  20. Does littoral sand bypass the head of Mugu Submarine Canyon? - a modeling study

    USGS Publications Warehouse

    Xu, Jingping; Elias, Edwin; Kinsman, Nicole

    2011-01-01

    A newly developed sand-tracer code for the process-based model Delft3D (Deltares, The Netherlands) was used to simulate the littoral transport near the head of the Mugu Submarine Canyon in California, USA. For westerly swells, which account for more than 90% of the wave conditions in the region, the sand tracers in the downcoast littoral drift were unable to bypass the canyon head. A flow convergence near the upcoast rim of the canyon intercepts the tracers and moves them either offshore onto the shelf just west of the canyon rim (low wave height conditions) or into the canyon head (storm wave conditions). This finding supports the notion that Mugu Canyon is the true terminus of the Santa Barbara Littoral Cell.

  1. Computing interaural differences through finite element modeling of idealized human heads

    PubMed Central

    Cai, Tingli; Rakerd, Brad; Hartmann, William M.

    2015-01-01

    Acoustical interaural differences were computed for a succession of idealized shapes approximating the human head-related anatomy: sphere, ellipsoid, and ellipsoid with neck and torso. Calculations were done as a function of frequency (100–2500 Hz) and for source azimuths from 10 to 90 degrees using finite element models. The computations were compared to free-field measurements made with a manikin. Compared to a spherical head, the ellipsoid produced greater large-scale variation with frequency in both interaural time differences and interaural level differences, resulting in better agreement with the measurements. Adding a torso, represented either as a large plate or as a rectangular box below the neck, further improved the agreement by adding smaller-scale frequency variation. The comparisons permitted conjectures about the relationship between details of interaural differences and gross features of the human anatomy, such as the height of the head, and length of the neck. PMID:26428792

  2. A link-segment model of upright human posture for analysis of head-trunk coordination

    NASA Technical Reports Server (NTRS)

    Nicholas, S. C.; Doxey-Gasway, D. D.; Paloski, W. H.

    1998-01-01

    Sensory-motor control of upright human posture may be organized in a top-down fashion such that certain head-trunk coordination strategies are employed to optimize visual and/or vestibular sensory inputs. Previous quantitative models of the biomechanics of human posture control have examined the simple case of ankle sway strategy, in which an inverted pendulum model is used, and the somewhat more complicated case of hip sway strategy, in which multisegment, articulated models are used. While these models can be used to quantify the gross dynamics of posture control, they are not sufficiently detailed to analyze head-trunk coordination strategies that may be crucial to understanding its underlying mechanisms. In this paper, we present a biomechanical model of upright human posture that extends an existing four mass, sagittal plane, link-segment model to a five mass model including an independent head link. The new model was developed to analyze segmental body movements during dynamic posturography experiments in order to study head-trunk coordination strategies and their influence on sensory inputs to balance control. It was designed specifically to analyze data collected on the EquiTest (NeuroCom International, Clackamas, OR) computerized dynamic posturography system, where the task of maintaining postural equilibrium may be challenged under conditions in which the visual surround, support surface, or both are in motion. The performance of the model was tested by comparing its estimated ground reaction forces to those measured directly by support surface force transducers. We conclude that this model will be a valuable analytical tool in the search for mechanisms of balance control.

  3. Quantitative Simulations of MST Visual Receptive Field Properties Using a Template Model of Heading Estimation

    NASA Technical Reports Server (NTRS)

    Stone, Leland S.; Perrone, J. A.

    1997-01-01

    We previously developed a template model of primate visual self-motion processing that proposes a specific set of projections from MT-like local motion sensors onto output units to estimate heading and relative depth from optic flow. At the time, we showed that that the model output units have emergent properties similar to those of MSTd neurons, although there was little physiological evidence to test the model more directly. We have now systematically examined the properties of the model using stimulus paradigms used by others in recent single-unit studies of MST: 1) 2-D bell-shaped heading tuning. Most MSTd neurons and model output units show bell-shaped heading tuning. Furthermore, we found that most model output units and the finely-sampled example neuron in the Duffy-Wurtz study are well fit by a 2D gaussian (sigma approx. 35deg, r approx. 0.9). The bandwidth of model and real units can explain why Lappe et al. found apparent sigmoidal tuning using a restricted range of stimuli (+/-40deg). 2) Spiral Tuning and Invariance. Graziano et al. found that many MST neurons appear tuned to a specific combination of rotation and expansion (spiral flow) and that this tuning changes little for approx. 10deg shifts in stimulus placement. Simulations of model output units under the same conditions quantitatively replicate this result. We conclude that a template architecture may underlie MT inputs to MST.

  4. Kinematic Model-Based Pedestrian Dead Reckoning for Heading Correction and Lower Body Motion Tracking

    PubMed Central

    Lee, Min Su; Ju, Hojin; Song, Jin Woo; Park, Chan Gook

    2015-01-01

    In this paper, we present a method for finding the enhanced heading and position of pedestrians by fusing the Zero velocity UPdaTe (ZUPT)-based pedestrian dead reckoning (PDR) and the kinematic constraints of the lower human body. ZUPT is a well known algorithm for PDR, and provides a sufficiently accurate position solution for short term periods, but it cannot guarantee a stable and reliable heading because it suffers from magnetic disturbance in determining heading angles, which degrades the overall position accuracy as time passes. The basic idea of the proposed algorithm is integrating the left and right foot positions obtained by ZUPTs with the heading and position information from an IMU mounted on the waist. To integrate this information, a kinematic model of the lower human body, which is calculated by using orientation sensors mounted on both thighs and calves, is adopted. We note that the position of the left and right feet cannot be apart because of the kinematic constraints of the body, so the kinematic model generates new measurements for the waist position. The Extended Kalman Filter (EKF) on the waist data that estimates and corrects error states uses these measurements and magnetic heading measurements, which enhances the heading accuracy. The updated position information is fed into the foot mounted sensors, and reupdate processes are performed to correct the position error of each foot. The proposed update-reupdate technique consequently ensures improved observability of error states and position accuracy. Moreover, the proposed method provides all the information about the lower human body, so that it can be applied more effectively to motion tracking. The effectiveness of the proposed algorithm is verified via experimental results, which show that a 1.25% Return Position Error (RPE) with respect to walking distance is achieved. PMID:26561814

  5. Kinematic Model-Based Pedestrian Dead Reckoning for Heading Correction and Lower Body Motion Tracking.

    PubMed

    Lee, Min Su; Ju, Hojin; Song, Jin Woo; Park, Chan Gook

    2015-01-01

    In this paper, we present a method for finding the enhanced heading and position of pedestrians by fusing the Zero velocity UPdaTe (ZUPT)-based pedestrian dead reckoning (PDR) and the kinematic constraints of the lower human body. ZUPT is a well known algorithm for PDR, and provides a sufficiently accurate position solution for short term periods, but it cannot guarantee a stable and reliable heading because it suffers from magnetic disturbance in determining heading angles, which degrades the overall position accuracy as time passes. The basic idea of the proposed algorithm is integrating the left and right foot positions obtained by ZUPTs with the heading and position information from an IMU mounted on the waist. To integrate this information, a kinematic model of the lower human body, which is calculated by using orientation sensors mounted on both thighs and calves, is adopted. We note that the position of the left and right feet cannot be apart because of the kinematic constraints of the body, so the kinematic model generates new measurements for the waist position. The Extended Kalman Filter (EKF) on the waist data that estimates and corrects error states uses these measurements and magnetic heading measurements, which enhances the heading accuracy. The updated position information is fed into the foot mounted sensors, and reupdate processes are performed to correct the position error of each foot. The proposed update-reupdate technique consequently ensures improved observability of error states and position accuracy. Moreover, the proposed method provides all the information about the lower human body, so that it can be applied more effectively to motion tracking. The effectiveness of the proposed algorithm is verified via experimental results, which show that a 1.25% Return Position Error (RPE) with respect to walking distance is achieved. PMID:26561814

  6. Femoral head viability following hip fracture. Prognostic role of radionuclide bone imaging

    SciTech Connect

    Drane, W.E.; Rudd, T.G.

    1985-03-01

    A retrospective study was made of all radionuclide (RN) bone images performed at our institution over a two-year period to evaluate femoral head viability after nonpathologic fracture of the femoral neck. Twelve patients had avascular femoral heads during the perioperative period, of which nine had adequate follow-up. Seven of these nine patients had follow-up bone images. Revascularization occurred in four patients, while three had persistent absence of femoral head uptake. With clinical follow-up ranging from four to 29 months (median: 14 months), only two of these nine patients developed clinical or radiographic evidence of osteonecrosis. RN bone imaging performed in the perioperative period does not reliably predict the development of post-traumatic osteonecrosis of the femoral head and, at present, should not be used to determine prospectively method of treatment of femoral neck fracture.

  7. Double Cluster Heads Model for Secure and Accurate Data Fusion in Wireless Sensor Networks

    PubMed Central

    Fu, Jun-Song; Liu, Yun

    2015-01-01

    Secure and accurate data fusion is an important issue in wireless sensor networks (WSNs) and has been extensively researched in the literature. In this paper, by combining clustering techniques, reputation and trust systems, and data fusion algorithms, we propose a novel cluster-based data fusion model called Double Cluster Heads Model (DCHM) for secure and accurate data fusion in WSNs. Different from traditional clustering models in WSNs, two cluster heads are selected after clustering for each cluster based on the reputation and trust system and they perform data fusion independently of each other. Then, the results are sent to the base station where the dissimilarity coefficient is computed. If the dissimilarity coefficient of the two data fusion results exceeds the threshold preset by the users, the cluster heads will be added to blacklist, and the cluster heads must be reelected by the sensor nodes in a cluster. Meanwhile, feedback is sent from the base station to the reputation and trust system, which can help us to identify and delete the compromised sensor nodes in time. Through a series of extensive simulations, we found that the DCHM performed very well in data fusion security and accuracy. PMID:25608211

  8. Uncertainties and correction methods when modeling passive scattering proton therapy treatment heads with Monte Carlo

    PubMed Central

    Bednarz, Bryan; Lu, Hsiao-Ming; Engelsman, Martijn; Paganetti, Harald

    2011-01-01

    Monte Carlo models of proton therapy treatment heads are being used to improve beam delivery systems and to calculate the radiation field for patient dose calculations. The achievable accuracy of the model depends on the exact knowledge of the treatment head geometry and time structure, the material characteristics, and the underlying physics. This work aimed at studying the uncertainties in treatment head simulations for passive scattering proton therapy. The sensitivities of spread-out Bragg peak (SOBP) dose distributions on material densities, mean ionization potentials, initial proton beam energy spread and spot size were investigated. An improved understanding of the nature of these parameters may help to improve agreement between calculated and measured SOBP dose distributions and to ensure that the range, modulation width, and uniformity are within clinical tolerance levels. Furthermore, we present a method to make small corrections to the uniformity of spread-out Bragg peaks by utilizing the time structure of the beam delivery. In addition, we re-commissioned the models of the two proton treatment heads located at our facility using the aforementioned correction methods presented in this paper. PMID:21478569

  9. A revised dosimetric model of the head and brain

    SciTech Connect

    Bolch, W.E.; Poston, J.W. Sr.

    1995-05-01

    The use of PET and SPECT radiopharmaceuticals in brain imaging has greatly expanded over the past several years. Many of these agents localize within particular subregions of the brain, thus allowing for detailed physiologic and metabolic imaging. Dosimetric models to support these advances in nuclear medicine have been lacking. For example, the brain within the phantom of MIRD Pamphlet No. 5 Revised is modeled simply as a single ellipsoid of tissue with no differentiation of its internal structures. To address this need, the MIRD Committee established a Task Group in 1992 to construct a revised dosimetric model of the brain to include the following subregions: the cerebral cortex, the white matter, the cerebellum, the thalamus, the caudate nucleus, the lentiform nucleus (putamen and globus pallidus), the cerebral spinal fluid (within the subarachnoid space of the brain), the lateral ventricles, and the third ventricle. Estimates of both electron and photon absorbed fractions (AF) were subsequently calculated using the EGS4 radiation transport code. For most of the internal brain structures, electron AFs are shown to fall fellow unity for all regions within the energy range of {approximately}200 keV to 4 MeV. For example, AFs for the caudate nucleus as both a source and target region and estimated as 0.98, 0.84, 0.39 for 200-keV, 1-MeV, and 4-MeV electron sources, respectively. Corresponding AFs within the white matter as a source and target region are estimated as 1.0, 0.95, and 0.79 for these same electron energies. Revised S values were subsequently calculated for a variety of beta-particle and positron emitters used in brain imaging.

  10. Osteonecrosis in Systemic Lupus Erythematosus: An Early, Frequent, and Not Always Symptomatic Complication

    PubMed Central

    Caramaschi, Paola; Biasi, Domenico; Dal Forno, Ilaria; Adami, Silvano

    2012-01-01

    Osteonecrosis may complicate the course of systemic lupus erythematosus and may contemporaneously affect multiple joints. The major risk factor associated with the development of osteonecrosis is the use of glucocorticoid at high doses. Recent studies using serial MRI, which represents the “gold standard” for the early detection of osteonecrosis, yielded some interesting findings about the natural history of this clinical entity. Osteonecrosis in the majority of the cases is asymptomatic and occurs early in the course of the disease. Its later occurrence is associated with lupus flare that requires the increase of corticosteroid dose. The optimal treatment of osteonecrosis is controversial. In case of silent osteonecrosis involving a small area conservative strategy is usually adequate. When lesions are symptomatic surgical treatment as core decompression or free vascularized fibular grafting is required; extracorporeal shockwave treatment may represent an alternative therapeutic approach. When the lesion has a medium-large dimension or involves a weight-bearing area bone collapse is a common complication requiring total joint replacement. Coadministration of bisphosphonate or warfarin with high doses of corticosteroid might be a promising preventive strategy of osteonecrosis. PMID:22919470

  11. Estimation of partial optical path length in the brain in subject-specific head models for near-infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    Nakamura, Kotaro; Kurihara, Kazuki; Kawaguchi, Hiroshi; Obata, Takayuki; Ito, Hiroshi; Okada, Eiji

    2016-04-01

    Three-dimensional head models with the structures constructed from the MR head images of 40 volunteers were constructed to analyze light propagation in the subject-specific head models. The mean optical path length in the head and the partial optical path length in the brain at 13 fiducial points for each volunteer were estimated to evaluate the intersubject and spatial variability in the optical path lengths. Although the intersubject variability in the optical path lengths is very high, the spatial variability in the average of the mean optical path length and partial optical path length is similar to the previously reported data. The mean optical path length in the head increases, whereas the partial optical path length in the brain decreases with an increase in the depth of the brain surface. The partial optical path length is highly correlated with the depth of the brain surface in comparison to the mean optical path length in the head.

  12. Computational Modeling of the Working Process in the Combustion Chamber for Casing-Head Gas Recovery

    NASA Astrophysics Data System (ADS)

    Bachev, N. L.; Betinskaya, O. A.; Bul‧bovich, R. V.

    2016-01-01

    The present paper considers problems of computational modeling of the working process in multizone combustion chambers (CC) forming a part of gas-turbine power plants for recovering casing-head and other process gases. To investigate the turbulent flow and combustion, we use the LES method with a Smagorinskii subnet model. Various schemes of feeding components into combustion and dilution zones are considered. A comparison is made between the calculated and experimental data on the temperature in the combustion zone.

  13. The role of blood vessels in high-resolution volume conductor head modeling of EEG.

    PubMed

    Fiederer, L D J; Vorwerk, J; Lucka, F; Dannhauer, M; Yang, S; Dümpelmann, M; Schulze-Bonhage, A; Aertsen, A; Speck, O; Wolters, C H; Ball, T

    2016-03-01

    Reconstruction of the electrical sources of human EEG activity at high spatio-temporal accuracy is an important aim in neuroscience and neurological diagnostics. Over the last decades, numerous studies have demonstrated that realistic modeling of head anatomy improves the accuracy of source reconstruction of EEG signals. For example, including a cerebro-spinal fluid compartment and the anisotropy of white matter electrical conductivity were both shown to significantly reduce modeling errors. Here, we for the first time quantify the role of detailed reconstructions of the cerebral blood vessels in volume conductor head modeling for EEG. To study the role of the highly arborized cerebral blood vessels, we created a submillimeter head model based on ultra-high-field-strength (7T) structural MRI datasets. Blood vessels (arteries and emissary/intraosseous veins) were segmented using Frangi multi-scale vesselness filtering. The final head model consisted of a geometry-adapted cubic mesh with over 17×10(6) nodes. We solved the forward model using a finite-element-method (FEM) transfer matrix approach, which allowed reducing computation times substantially and quantified the importance of the blood vessel compartment by computing forward and inverse errors resulting from ignoring the blood vessels. Our results show that ignoring emissary veins piercing the skull leads to focal localization errors of approx. 5 to 15mm. Large errors (>2cm) were observed due to the carotid arteries and the dense arterial vasculature in areas such as in the insula or in the medial temporal lobe. Thus, in such predisposed areas, errors caused by neglecting blood vessels can reach similar magnitudes as those previously reported for neglecting white matter anisotropy, the CSF or the dura - structures which are generally considered important components of realistic EEG head models. Our findings thus imply that including a realistic blood vessel compartment in EEG head models will be helpful to

  14. Bisphosphonate-associated osteonecrosis of the jaw: the rheumatologist's role

    PubMed Central

    Capsoni, Franco; Longhi, Matteo; Weinstein, Roberto

    2006-01-01

    Several recent reports have described osteonecrosis of the jaws (ONJ) associated with the use of bisphosphonates. Rheumatologists treating bone diseases with bisphosphonate need, therefore, to be aware of this potential risk and plan the prophylaxis, early diagnosis and prevention of potential consequences. We review the literature on this newly described complication, with particular focus on systemic and local predisposing pathologies, preventive measures suggested before and during therapy with bisphosphonates, and the most frequent clinical presentation of the oral lesions. The expert panel recommendations for the management of care of patients who develop ONJ are summarized. PMID:17049069

  15. Osteonecrosis of the jaw in patient with denosumab therapy

    PubMed Central

    Olate, Sergio; Uribe, Francisca; Martinez, Felipe; Almeida, Andrés; Unibazo, Alejandro

    2014-01-01

    Osteonecrosis (ON) of the jaw has previously been linked to the use of biphosphonates; however, new drugs, also shown similar conditions. This article presents a female patient with mandibular ON related to the use of denosumab. The 55-year-old presented with bone exposure with 8 months of evolution after a dental extraction. The patient began subcutaneous injections of 60 mg denosumab four months prior to the extraction and the lesion remained after the procedure. The patient, with 14 months of follow-up, show mandible ON with no favorable evolution. The clinical condition is presented and the literature of ON associated with denosumab is discussed. PMID:25419421

  16. Concomitant Factors Leading to an Atypical Osteonecrosis of the Jaw in a Patient with Multiple Myeloma

    PubMed Central

    Miranda-Rius, Jaume; Brunet-Llobet, Lluís; Lahor-Soler, Eduard; Giménez-Rubio, Josep Anton

    2014-01-01

    Osteonecrosis of the jaw (ONJ) is a site specific osseous pathology, characterized by chronic exposed bone in the mouth, which needs to be reinforced periodically within the medical literature. ONJ is a clinical entity with many possible aetiologies and its pathogenesis is not well understood. The risk factors for ONJ include bisphosphonates treatments, head and neck radiotherapy, dental procedures involving bone surgery, and trauma. Management of ONJ has centred on efforts to eliminate or reduce severity of symptoms, to slow or prevent the progression of disease, and to eradicate diseased bone. This case describes a rare case of ONJ in a 64-year-old Caucasian male diagnosed with multiple myeloma stage III. The lesion was related to a traumatic injury during mastication. Eighteen months ago in the same area the molar 37 was extracted, achieving a complete satisfactory healing, when only 2 doses of zoledronic acid had been administered. Actinomyces bacterial aggregates were also identified in the microscopic analysis. The management of this osteonecrotic lesion included antibiotic treatment and chlorhexidine topical gel administration. The evolution was monitored every two weeks until patient's death. The authors provide a discussion of the etiology, pathogenesis, diagnosis, and management. This case report may shed light on the controversies about concomitant factors and mechanisms inducing ONJ. PMID:25140178

  17. Computational modeling of human head under blast in confined and open spaces: primary blast injury.

    PubMed

    Rezaei, A; Salimi Jazi, M; Karami, G

    2014-01-01

    In this paper, a computational modeling for biomechanical analysis of primary blast injuries is presented. The responses of the brain in terms of mechanical parameters under different blast spaces including open, semi-confined, and confined environments are studied. In the study, the effect of direct and indirect blast waves from the neighboring walls in the confined environments will be taken into consideration. A 50th percentile finite element head model is exposed to blast waves of different intensities. In the open space, the head experiences a sudden intracranial pressure (ICP) change, which vanishes in a matter of a few milliseconds. The situation is similar in semi-confined space, but in the confined space, the reflections from the walls will create a number of subsequent peaks in ICP with a longer duration. The analysis procedure is based on a simultaneous interaction simulation of the deformable head and its components with the blast wave propagations. It is concluded that compared with the open and semi-confined space settings, the walls in the confined space scenario enhance the risk of primary blast injuries considerably because of indirect blast waves transferring a larger amount of damaging energy to the head. PMID:23996897

  18. Rapidly re-computable EEG (electroencephalography) forward models for realistic head shapes

    SciTech Connect

    Ermer, J. J.; Mosher, J. C.; Baillet, S.; Leahy, R. M.

    2001-01-01

    Solution of the EEG source localization (inverse) problem utilizing model-based methods typically requires a significant number of forward model evaluations. For subspace based inverse methods like MUSIC [6], the total number of forward model evaluations can often approach an order of 10{sup 3} or 10{sup 4}. Techniques based on least-squares minimization may require significantly more evaluations. The observed set of measurements over an M-sensor array is often expressed as a linear forward spatio-temporal model of the form: F = GQ + N (1) where the observed forward field F (M-sensors x N-time samples) can be expressed in terms of the forward model G, a set of dipole moment(s) Q (3xP-dipoles x N-time samples) and additive noise N. Because of their simplicity, ease of computation, and relatively good accuracy, multi-layer spherical models [7] (or fast approximations described in [1], [7]) have traditionally been the 'forward model of choice' for approximating the human head. However, approximation of the human head via a spherical model does have several key drawbacks. By its very shape, the use of a spherical model distorts the true distribution of passive currents in the skull cavity. Spherical models also require that the sensor positions be projected onto the fitted sphere (Fig. 1), resulting in a distortion of the true sensor-dipole spatial geometry (and ultimately the computed surface potential). The use of a single 'best-fitted' sphere has the added drawback of incomplete coverage of the inner skull region, often ignoring areas such as the frontal cortex. In practice, this problem is typically countered by fitting additional sphere(s) to those region(s) not covered by the primary sphere. The use of these additional spheres results in added complication to the forward model. Using high-resolution spatial information obtained via X-ray CT or MR imaging, a realistic head model can be formed by tessellating the head into a set of contiguous regions (typically the

  19. Maxilla Osteonecrosis: a differential diagnosis in patients with metastatic cancer on bisphosphonates

    PubMed Central

    Smith, Joshua; Birkeland, Andrew C.; McHugh, Jonathan B.; Spector, Matthew E.

    2016-01-01

    Bisphosphonate-induced osteonecrosis of the mandible and/or maxilla is an increasingly recognized, though still rare complication of bisphosphonate therapy. In the present case, the patient presented with a seven-month history of maxillary sinusitis and pain, and was originally diagnosed with a bony metastasis from her primary breast cancer. However, surgical excision and biopsy led to a diagnosis of bisphosphonate-induced osteonecrosis of the maxilla. As bisphosphonates are often prescribed for patients with metastatic disease, it is important to recognize that bisphosphonate-induced osteonecrosis may present similarly to bony metastases. PMID:27347432

  20. A mouse model of weight-drop closed head injury: emphasis on cognitive and neurological deficiency.

    PubMed

    Khalin, Igor; Jamari, Nor Laili Azua; Razak, Nadiawati Bt Abdul; Hasain, Zubaidah Bt; Nor, Mohd Asri Bin Mohd; Zainudin, Mohd Hakimi Bin Ahmad; Omar, Ainsah Bt; Alyautdin, Renad

    2016-04-01

    Traumatic brain injury (TBI) is a leading cause of death and disability in individuals worldwide. Producing a clinically relevant TBI model in small-sized animals remains fairly challenging. For good screening of potential therapeutics, which are effective in the treatment of TBI, animal models of TBI should be established and standardized. In this study, we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model. We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice. Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury. Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI. PMID:27212925

  1. A mouse model of weight-drop closed head injury: emphasis on cognitive and neurological deficiency

    PubMed Central

    Khalin, Igor; Jamari, Nor Laili Azua; Razak, Nadiawati Bt Abdul; Hasain, Zubaidah Bt; Nor, Mohd Asri bin Mohd; Zainudin, Mohd Hakimi bin Ahmad; Omar, Ainsah Bt; Alyautdin, Renad

    2016-01-01

    Traumatic brain injury (TBI) is a leading cause of death and disability in individuals worldwide. Producing a clinically relevant TBI model in small-sized animals remains fairly challenging. For good screening of potential therapeutics, which are effective in the treatment of TBI, animal models of TBI should be established and standardized. In this study, we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model. We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice. Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury. Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI. PMID:27212925

  2. Alterations of sympathetic nerve fibers in avascular necrosis of femoral head

    PubMed Central

    Li, Deqiang; Liu, Peilai; Zhang, Yuankai; Li, Ming

    2015-01-01

    Objectives: Avascular necrosis of the femoral head (ANFH) was mainly due to alterations of bone vascularity. And noradrenaline (NA), as the neurotransmitter of the sympathetic nervous system (SNS), leads to the vasoconstriction by activating its α-Receptor. This study was to explore the nerve fiber density of the femoral head in the rabbit model of ANFH. Methods: Twenty New Zealand white rabbits were used in this study. The rabbit model of ANFH was established by the injection of methylprednisolone acetate. The nerve fiber density and distribution in the femoral head was determined using an Olympus BH2 microscope. Results: Significant fewer sympathetic nerve fibers was found in the ANFH intertrochanteric bone samples (P = 0.036) with osteonecrosis. The number of sympathetic nerve fibers was compared between the two groups. And less sympathetic nerve fibers were found in later stage ANFH samples in comparison with those of early stages. Conclusions: ANFH might be preceded by an inflammatory reaction, and an inflammatory response might lead to arthritic changes in tissue samples, which in turn reduces the number of sympathetic nerve fibers. PMID:26617812

  3. A head impact model of early axonal injury in the sheep.

    PubMed

    Lewis, S B; Finnie, J W; Blumbergs, P C; Scott, G; Manavis, J; Brown, C; Reilly, P L; Jones, N R; McLean, A J

    1996-09-01

    Axonal injury (AI), one of the principal determinants of clinical outcome after head injury, may evolve over several hours after injury, raising the future possibility of therapeutic intervention during this period. A new head impact model of AI in sheep was developed to examine pathological and physiological changes in the brain resulting from a graded traumatic insult. In this preliminary study 10 anesthetized and ventilated Merino ewes were used. Head injury was produced by impact from a humane stunner to the temporal region of an unrestrained head. Eight sheep were studied for 1, 2, 4, or 6 h after impact. Two sham animals (no impact, 6 h survival) were also examined. Arterial blood pressure, intracranial pressure, and cerebral blood flow were monitored continuously. A physiological index of injury severity was calculated by weighting the percentage shift from preinjury values for each monitored parameter over the first hour after injury. Immunostaining with amyloid precursor protein (APP) was used as a marker of axonal damage and the distribution of APP positive axons was recorded according to a sector scoring method (APPS). Widespread AI was identified in 7 of the 8 impacted animals, around cerebral contusions and in hemispheric white matter, central gray matter, brain stem, and cerebellum, and was detected as early as 1 h after injury. The degree of axonal injury (APPS) correlated well with an index of physiological response to injury (r = 0.83, p = 0.005). PMID:8913967

  4. Analysis of head-down tilt as an analog of weightlessness using a methematical simulation model

    NASA Technical Reports Server (NTRS)

    Leonard, J. I.

    1984-01-01

    Antiorthostasis or head down tilt of a moderate degree was used as a ground based analog of weightless space flight to study headward fluid shifts, decreased plasma volume, orthostatic intolerance and muscular skeletal degradation. A mathematical model was used to help interpret these observations. The model proved most valuable for these studies was originally developed as a description of the major circulatory, fluid and electrolyte control systems. Two different experimental studies are employed to validate the model. The first is a 24 hour head down tilt study and the second is a 7 day head down bed rest study. The major issues addressed include the reduction in plasma volume, the dynamic changes of venous pressure and cardiac output, the extent of central hypervolemia during long term zero g exposure, the existence of an early diuresis, the mechanisms which alter the renal regulating hormones during the short term and long term periods, the significance of potassium loss on other zero g responses, and the role of transcapillary filtration in adjusting fluid shifts. The use of mathematical models as an interpretive and analysis technique for experimental research for space life science is illustrated.

  5. Heading recovery from optic flow: comparing performance of humans and computational models

    PubMed Central

    Foulkes, Andrew J.; Rushton, Simon K.; Warren, Paul A.

    2013-01-01

    Human observers can perceive their direction of heading with a precision of about a degree. Several computational models of the processes underpinning the perception of heading have been proposed. In the present study we set out to assess which of four candidate models best captured human performance; the four models we selected reflected key differences in terms of approach and methods to modelling optic flow processing to recover movement parameters. We first generated a performance profile for human observers by measuring how performance changed as we systematically manipulated both the quantity (number of dots in the stimulus per frame) and quality (amount of 2D directional noise) of the flow field information. We then generated comparable performance profiles for the four candidate models. Models varied markedly in terms of both their performance and similarity to human data. To formally assess the match between the models and human performance we regressed the output of each of the four models against human performance data. We were able to rule out two models that produced very different performance profiles to human observers. The remaining two shared some similarities with human performance profiles in terms of the magnitude and pattern of thresholds. However none of the models tested could capture all aspect of the human data. PMID:23801946

  6. Applying the SNOMED CT Concept Model to Represent Value Sets for Head and Neck Cancer Documentation.

    PubMed

    Højen, Anne Randorff; Brønnum, Dorthe; Gøeg, Kirstine Rosenbeck; Elberg, Pia Britt

    2016-01-01

    This paper presents an analysis of the extent to which SNOMED CT is suitable for representing data within the domain of head and neck cancer. In this analysis we assess whether the concept model of SNOMED CT comply with the documentation needed within this clinical domain. Attributes from the follow-up template of the clinical quality registry for Danish Head and Neck Cancer, and their respective value sets were mapped to SNOMED CT using existing mapping guidelines. Results show that post-coordination is important to represent specific types of value sets, such as absence of findings and severities. The concept model of SNOMED CT was found suitable for representing the value sets of this material. We argue for the development of further mapping guidelines for consistent post-coordination and for initiatives that demonstrate use of this important terminological feature in actual SNOMED CT implementations. PMID:27577420

  7. Lamb’s head: The model for novice education in endoscopic sinus surgery

    PubMed Central

    Skitarelić, Neven; Mladina, Ranko

    2015-01-01

    Structured training in endonasal endoscopic sinus surgery (EESS) and skull base surgery is essential considering serious potential complications. We have developed a detailed concept on training these surgical skills on the lamb’s head. This simple and extremely cheap model offers the possibility of training even more demanding and advanced procedures in human endonasal endoscopic surgery such as: frontal sinus surgery, orbital decompression, cerebrospinal fluid-leak repair followed also by the naso-septal flap, etc. Unfortunately, the sphenoid sinus surgery cannot be practiced since quadrupeds do not have this sinus. Still, despite this anatomical limitation, it seems that the lamb’s head can be very useful even for the surgeons already practicing EESS, but in a limited edition because of a lack of the experience and dexterity. Only after gaining the essential surgical skills of this demanding field it makes sense to go for the expensive trainings on the human cadaveric model. PMID:26413487

  8. Lamb's head: The model for novice education in endoscopic sinus surgery.

    PubMed

    Skitarelić, Neven; Mladina, Ranko

    2015-09-26

    Structured training in endonasal endoscopic sinus surgery (EESS) and skull base surgery is essential considering serious potential complications. We have developed a detailed concept on training these surgical skills on the lamb's head. This simple and extremely cheap model offers the possibility of training even more demanding and advanced procedures in human endonasal endoscopic surgery such as: frontal sinus surgery, orbital decompression, cerebrospinal fluid-leak repair followed also by the naso-septal flap, etc. Unfortunately, the sphenoid sinus surgery cannot be practiced since quadrupeds do not have this sinus. Still, despite this anatomical limitation, it seems that the lamb's head can be very useful even for the surgeons already practicing EESS, but in a limited edition because of a lack of the experience and dexterity. Only after gaining the essential surgical skills of this demanding field it makes sense to go for the expensive trainings on the human cadaveric model. PMID:26413487

  9. Mapping the brain cortex using an analytical model of the head

    NASA Astrophysics Data System (ADS)

    Hollaender, Igor

    1995-04-01

    In neurosciences, 3D renderings of the human brain cortex based on MR tomographical measurements are often used to study cortical structures, their similarity or variability, or to depict surface distribution of a given physical quantity. We have developed a method for producing maps of the human cortex depicting the complete brain surface in one view. The mapping is based on casting rays normal to the skin surface of the head. The projection surface is then remapped to the plane. An analytical model of the head consisting of four Bezier patches is used for generating the normal rays. The contribution describes the structure of the model and its computation, the projection geometry of the mapping, and the details of the rendering phase. Examples of possible applications of the method are presented.

  10. Head and neck resonance in a rhesus monkey - a comparison with results from a human model

    NASA Astrophysics Data System (ADS)

    Tinniswood, Adam; Gandhi, Om P.

    1999-03-01

    The use of primates for examining the effects of electromagnetic radiation on behavioural patterns is well established. Rats have also been used for this purpose. However, the monkey is of greater interest as its physiological make-up is somewhat closer to that of the human. Since the behavioural effects are likely to occur at lower field strengths for resonant absorption conditions for the head and neck, the need for determination of resonance frequencies for this region is obvious. Numerical techniques are ideal for the prediction of coupling to each of the organs, and accurate anatomically based models can be used to pinpoint the conditions for maximum absorption in the head in order to focus the experiments. In this paper we use two models, one of a human male and the other of a rhesus monkey, and find the mass-averaged power absorption spectra for both. The frequencies at which highest absorption (i.e. resonance) occurs in both the whole body and the head and neck region are determined. The results from these two models are compared for both E-polarization and k-polarization, and are shown to obey basic electromagnetic scaling principles.

  11. Development of a Human Head FE Model and Impact Simulation on the Focal Brain Injury

    NASA Astrophysics Data System (ADS)

    Watanabe, Dai; Yuge, Kohei; Nishimoto, Tetsuya; Murakami, Shigeyuki; Takao, Hiroyuki

    In this paper, a three-dimensional digital human-head model was developed and several dynamic analyses on the head trauma were conducted. This model was built up by the VOXEL approach using 433 slice CT images (512×512 pixels) and made of 1.22 million parallelepiped finite elements with 10 anatomical tissue properties such as scalp, CSF, skull, brain, dura mater and so on. The numerical analyses were conducted using a finite element code the authors have developed. The main features of the code are 1) it is based on the explicit time integration method and 2) it uses the one point integration method to evaluate the equivalent nodal forces with the hourglass control proposed by Flanagan and Belytschko(1) and 3) it utilizes the parallel computation system based on MPI. In order to verify the developed model, the head impact experiment for a cadaver by Nahum et al.(2) was simulated. The calculated results showed good agreement with the experimental ones. A front and rear impact analyses were also performed to discuss on the characteristic measure of the brain injury, in which the von-Mises stress was high in the frontal lobe in both of the analyses because of the large deformations of a frontal cranial base. This result suggests that the von-Mises stress can be a good measure of the brain injury since it is empirically well known that the frontal lobe tends to get injured regardless of the impact positions.

  12. Osteonecrosis of Interphalangeal Joint of Thumb Two Months after Rattlesnake Bite.

    PubMed

    Bonasso, Patrick; Lucke-Wold, Brandon; Jacob, Glen

    2015-01-01

    This case report details the osteonecrosis of the interphalangeal (IP) joint of the thumb two months after a rattlesnake bite. It describes the clinical presentation, imaging studies, histological review, pathology review, and review of literature. Our patient was a fifty-one year-old male who obtained a poisonous snakebite to the thumb. While in the hospital for acute treatment, a blood blister was debrided. He was seen two weeks after discharge for further debridement of epidermolysis. Patient presented one month later with a hand x-ray demonstrating bony erosions, and a bone scan showing active changes in the IP joint of his right thumb. He was taken to the OR for further debridement and definitive diagnosis. Pathology results confirmed osteonecrosis with negative bone cultures. The clinical presentation, diagnosis, and operative management of osteonecrosis offer a unique challenge, especially in a patient presenting with osteonecrosis from a poisonous snakebite. PMID:26051782

  13. [Toxic phosphorous osteonecrosis of facial bones among drug addicts to desomorphine and pervitin. Part II].

    PubMed

    Basin, E M; Medvedev, Yu A

    2015-01-01

    Article describes literature review of "atypical" osteomyelitis--osteonecrosis of facial bones among addicts to synthetic narcotics desomorphine and pervitin, different comorbidities, treatment strategy and prognosis were outlined PMID:26331178

  14. Osteonecrosis of the mandibular condyle as a precursor to osteoarthrosis: a case report.

    PubMed

    Fu, Kai-Yuan; Li, You-Wei; Zhang, Zhen-Kang; Ma, Xu-Chen

    2009-01-01

    Osteonecrosis of the mandibular condyle is a rare condition characterized by a primary subchondral osseous breakdown of the condyle with secondary articular surface collapse. Despite these characteristics, it has proved to be difficult to diagnose. The present case of osteonecrosis of the mandibular condyle was initially diagnosed more than 2 years before. The diagnosis at that time was based on physical examination, plain film radiography, cone-beam computerized tomography, magnetic resonance imaging, and total body scintigraphy. The disease had progressed into severe osteoarthrosis at a 2-year follow-up using cone-beam computerized tomography. This report suggests that osteonecrosis may be a precursor of osteoarthrosis, and cone-beam computerized tomography may provide a sensitive radiographic technique for the diagnosis of osteonecrosis of mandibular condyle. PMID:19101480

  15. Development of an FE model of the rat head subjected to air shock loading.

    PubMed

    Zhu, Feng; Mao, Haojie; Dal Cengio Leonardi, Alessandra; Wagner, Christina; Chou, Clifford; Jin, Xin; Bir, Cynthia; Vandevord, Pamela; Yang, King H; King, Albert I

    2010-11-01

    As early as the 1950's, Gurdjian and colleagues (Gurdjian et al. 1955) observed that brain injuries could occur by direct pressure loading without any global head accelerations. This pressure-induced injury mechanism was "forgotten" for some time and is being rekindled due to the many mild traumatic brain injuries attributed to blast overpressure. The aim of the current study was to develop a finite element (FE) model to predict the biomechanical response of rat brain under a shock tube environment. The rat head model, including more than 530,000 hexahedral elements with a typical element size of 100 to 300 microns was developed based on a previous rat brain model for simulating a blunt controlled cortical impact. An FE model, which represents gas flow in a 0.305-m diameter shock tube, was formulated to provide input (incident) blast overpressures to the rat model. It used an Eulerian approach and the predicted pressures were verified with experimental data. These two models were integrated and an arbitrary Lagrangian-Eulerian (ALE) fluid-structure coupling algorithm was then utilized to simulate the interaction of the shock wave with the rat head. The FE model-predicted pressure-time histories at the cortex and in the lateral ventricle were in reasonable agreement with those obtained experimentally. Further examination of the FE model predictions revealed that pressure amplification, caused by shock wave reflection at the interface of the materials with distinct wave impedances, was found in the skull. The overpressures in the anterior and posterior regions were 50% higher than those at the vertex and central regions, indicating a higher possibility of injuries in the coup and contrecoup sites. At an incident pressure of 85 kPa, the shear stress and principal strain in the brain remained at a low level, implying that they are not the main mechanism causing injury in the current scenario. PMID:21512910

  16. Resistor mesh model of a spherical head: part 1: applications to scalp potential interpolation.

    PubMed

    Chauveau, N; Morucci, J P; Franceries, X; Celsis, P; Rigaud, B

    2005-11-01

    A resistor mesh model (RMM) has been implemented to describe the electrical properties of the head and the configuration of the intracerebral current sources by simulation of forward and inverse problems in electroencephalogram/event related potential (EEG/ERP) studies. For this study, the RMM representing the three basic tissues of the human head (brain, skull and scalp) was superimposed on a spherical volume mimicking the head volume: it included 43 102 resistances and 14 123 nodes. The validation was performed with reference to the analytical model by consideration of a set of four dipoles close to the cortex. Using the RMM and the chosen dipoles, four distinct families of interpolation technique (nearest neighbour, polynomial, splines and lead fields) were tested and compared so that the scalp potentials could be recovered from the electrode potentials. The 3D spline interpolation and the inverse forward technique (IFT) gave the best results. The IFT is very easy to use when the lead-field matrix between scalp electrodes and cortex nodes has been calculated. By simple application of the Moore-Penrose pseudo inverse matrix to the electrode cap potentials, a set of current sources on the cortex is obtained. Then, the forward problem using these cortex sources renders all the scalp potentials. PMID:16594294

  17. Management and treatment of osteonecrosis in children and adolescents with acute lymphoblastic leukemia

    PubMed Central

    te Winkel, Mariël L.; Pieters, Rob; Wind, Ernst-Jan D.; Bessems, J.H.J.M. (Gert); van den Heuvel-Eibrink, Marry M.

    2014-01-01

    There is no consensus regarding how to manage osteonecrosis in pediatric acute lymphoblastic leukemia patients. Therefore, we performed a quality assessment of the literature with the result of a search strategy using the MESH terms osteonecrosis, children, childhood cancer, surgery, bisphosphonates, 6 hydroxymethyl-glutaryl CoA reductase inhibitors, anticoagulants and hyperbaric oxygen, and terms related to these MESH terms. A randomized controlled trial showed that osteonecrosis can be prevented by intermittent, instead of continuous, corticosteroid administration. The studies on interventions after onset of osteonecrosis were of low-quality evidence. Seven pediatric acute lymphoblastic leukemia studies described non-surgical interventions; bisphosphonates (n=5), hyperbaric oxygen therapy (n=1), or prostacyclin analogs (n=1). Safety and efficacy studies are lacking. Five studies focused on surgical interventions; none was of sufficient quality to draw definite conclusions. In conclusion, preventing osteonecrosis is feasible in a proportion of the pediatric acute lymphoblastic leukemia patients by discontinuous, instead of continuous, steroid scheduling. The questions as to how to treat childhood acute lymphoblastic leukemia patients with osteonecrosis cannot be answered as good-quality studies are lacking. PMID:24598854

  18. Bisphosphonate-induced osteonecrosis of the external ear canal: a retrospective study.

    PubMed

    Froelich, K; Radeloff, A; Köhler, C; Mlynski, R; Müller, J; Hagen, R; Kleinsasser, N H

    2011-08-01

    In 2003, osteonecrosis of the jaw was described as an intraoral complication of bisphosphonate therapy. More recently, cases of avascular necrosis of the hip were reported in patients with long-lasting bisphosphonate therapy. Thus, it was the aim of the present study to analyze cases of benign osteonecrosis of the external ear canal and to retrospectively identify a possible relationship to long-lasting bisphosphonate therapy. 13 patients with osteonecrosis of the external ear canal operated on between 2005 and 2009 were included. Patient histories were reviewed for possible previous or current bisphosphonate therapy. Three patients with osteonecrosis of the external ear canal and long-term bisphosphonate therapy could be identified. They had been treated either for breast cancer or multiple myeloma. Certainly, the jaw is an area of increased risk for developing osteonecrosis with its high mechanical stress and intraoral bacterial flora. However, osteonecrosis of the hips and the external ear canal in patients receiving long-term bisphosphonate therapy necessitate further investigation of a possible systemic, bisphosphonate-related phenomenon. PMID:21327733

  19. Novel Model of Frontal Impact Closed Head Injury in the Rat

    PubMed Central

    Kilbourne, Michael; Kuehn, Reed; Tosun, Cigdem; Caridi, John; Keledjian, Kaspar; Bochicchio, Grant; Scalea, Thomas; Gerzanich, Volodymyr

    2009-01-01

    Abstract Frontal impact, closed head trauma is a frequent cause of traumatic brain injury (TBI) in motor vehicle and sports accidents. Diffuse axonal injury (DAI) is common in humans and experimental animals, and results from shearing forces that develop within the anisotropic brain. Because the specific anisotropic properties of the brain are axis-dependent, the anatomical site where force is applied as well as the resultant acceleration, be it linear, rotational, or some combination, are important determinants of the resulting pattern of brain injury. Available rodent models of closed head injury do not reproduce the frontal impact commonly encountered in humans. Here we describe a new rat model of closed head injury that is a modification of the impact-acceleration model of Marmarou. In our model (the Maryland model), the impact force is applied to the anterior part of the cranium and produces TBI by causing anterior-posterior plus sagittal rotational acceleration of the brain inside the intact cranium. Skull fractures, prolonged apnea, and mortality were absent. The animals exhibited petechial hemorrhages, DAI marked by a bead-like pattern of β-amyloid precursor protein (β-APP) in damaged axons, and widespread upregulation of β-APP in neurons, with regions affected including the orbitofrontal cortex (coup), corpus callosum, caudate, putamen, thalamus, cerebellum, and brainstem. Activated caspase-3 was prominent in hippocampal neurons and Purkinje cells at the grey-white matter junction of the cerebellum. Neurobehavioral dysfunction, manifesting as reduced spontaneous exploration, lasted more than 1 week. We conclude that the Maryland model produces diffuse injuries that may be relevant to human brain injury. PMID:19929375

  20. Segmentation of T1 MR scans for reconstruction of resistive head models.

    PubMed

    Heinonen, T; Eskola, H; Dastidar, P; Laarne, P; Malmivuo, J

    1997-11-01

    This paper describes a segmentation method primarily developed for reconstructing resistive head models for electroencephalographic modelling purposes. The method was implemented by combining several image processing techniques, such as amplitude segmentation, region growing, and image fusion. Also a graphical user interface was developed to enable semiautomatic approach to the segmentation process. This method was developed especially for segmentation of the brain and skull from T1-weighted magnetic resonance images, but can also be applied in any segmentation procedure. The entire project was implemented successfully in a PC-based computer running the Unix/NeXTstep operating system. PMID:9421663

  1. Multi-scale/multi-physical modeling in head/disk interface of magnetic data storage

    NASA Astrophysics Data System (ADS)

    Chung, Pil Seung; Smith, Robert; Vemuri, Sesha Hari; Jhon, Young In; Tak, Kyungjae; Moon, Il; Biegler, Lorenz T.; Jhon, Myung S.

    2012-04-01

    The model integration of the head-disk interface (HDI) in the hard disk drive system, which includes the hierarchy of highly interactive layers (magnetic layer, carbon overcoat (COC), lubricant, and air bearing system (ABS)), has recently been focused upon to resolve technical barriers and enhance reliability. Heat-assisted magnetic recording especially demands that the model simultaneously incorporates thermal and mechanical phenomena by considering the enormous combinatorial cases of materials and multi-scale/multi-physical phenomena. In this paper, we explore multi-scale/multi-physical simulation methods for HDI, which will holistically integrate magnetic layers, COC, lubricants, and ABS in non-isothermal conditions.

  2. Mechanical Behaviour of Umbrella-Shaped, Ni-Ti Memory Alloy Femoral Head Support Device during Implant Operation: A Finite Element Analysis Study

    PubMed Central

    Yi, Wei; Tian, Qing; Dai, Zhipeng; Liu, Xiaohu

    2014-01-01

    A new instrument used for treating femoral head osteonecrosis was recently proposed: the umbrella-shaped, Ni-Ti memory femoral head support device. The device has an efficacy rate of 82.35%. Traditional radiographic study provides limited information about the mechanical behaviour of the support device during an implant operation. Thus, this study proposes a finite element analysis method, which includes a 3-step formal head model construction scheme and a unique material assignment strategy for evaluating mechanical behaviour during an implant operation. Four different scenarios with different constraints, initial positions and bone qualities are analyzed using the simulation method. The max radium of the implanted device was consistent with observation data, which confirms the accuracy of the proposed method. To ensure that the device does not unexpectedly open and puncture the femoral head, the constraint on the impact device should be strong. The initial position of sleeve should be in the middle to reduce the damage to the decompression channel. The operation may fail because of poor bone quality caused by severe osteoporosis. The proposed finite element analysis method has proven to be an accurate tool for studying the mechanical behaviour of umbrella-shaped, Ni-Ti memory alloy femoral head support device during an implant operation. The 3-step construct scheme can be implemented with any kind of bone structure meshed with multiple element types. PMID:24960038

  3. Stereoscopic vascular models of the head and neck: A computed tomography angiography visualization.

    PubMed

    Cui, Dongmei; Lynch, James C; Smith, Andrew D; Wilson, Timothy D; Lehman, Michael N

    2016-01-01

    Computer-assisted 3D models are used in some medical and allied health science schools; however, they are often limited to online use and 2D flat screen-based imaging. Few schools take advantage of 3D stereoscopic learning tools in anatomy education and clinically relevant anatomical variations when teaching anatomy. A new approach to teaching anatomy includes use of computed tomography angiography (CTA) images of the head and neck to create clinically relevant 3D stereoscopic virtual models. These high resolution images of the arteries can be used in unique and innovative ways to create 3D virtual models of the vasculature as a tool for teaching anatomy. Blood vessel 3D models are presented stereoscopically in a virtual reality environment, can be rotated 360° in all axes, and magnified according to need. In addition, flexible views of internal structures are possible. Images are displayed in a stereoscopic mode, and students view images in a small theater-like classroom while wearing polarized 3D glasses. Reconstructed 3D models enable students to visualize vascular structures with clinically relevant anatomical variations in the head and neck and appreciate spatial relationships among the blood vessels, the skull and the skin. PMID:25929248

  4. Modeling the direction-continuous time-of-arrival in head-related transfer functions.

    PubMed

    Ziegelwanger, Harald; Majdak, Piotr

    2014-03-01

    Head-related transfer functions (HRTFs) describe the filtering of the incoming sound by the torso, head, and pinna. As a consequence of the propagation path from the source to the ear, each HRTF contains a direction-dependent, broadband time-of-arrival (TOA). TOAs are usually estimated independently for each direction from HRTFs, a method prone to artifacts and limited by the spatial sampling. In this study, a continuous-direction TOA model combined with an outlier-removal algorithm is proposed. The model is based on a simplified geometric representation of the listener, and his/her arbitrary position within the HRTF measurement. The outlier-removal procedure uses the extreme studentized deviation test to remove implausible TOAs. The model was evaluated for numerically calculated HRTFs of sphere, torso, and pinna under various conditions. The accuracy of estimated parameters was within the resolution given by the sampling rate. Applied to acoustically measured HRTFs of 172 listeners, the estimated parameters were consistent with realistic listener geometry. The outlier removal further improved the goodness-of-fit, particularly for some problematic fits. The comparison with a simpler model that fixed the listener position to the center of the measurement geometry showed a clear advantage of listener position as an additional free model parameter. PMID:24606268

  5. Heads Up

    MedlinePlus

    ... Juvenil HEADS UP to School Sports Online Concussion Training Coaches Parents Athletes Sports Officials HEADS UP to Schools School Nurses Teachers, Counselors, and School Professionals Parents HEADS UP ...

  6. Evaluation of three-dimensional anisotropic head model for mapping realistic electromagnetic fields of brain tissues

    NASA Astrophysics Data System (ADS)

    Jeong, Woo Chul; Wi, Hun; Sajib, Saurav Z. K.; Oh, Tong In; Kim, Hyung Joong; Kwon, Oh In; Woo, Eung Je

    2015-08-01

    Electromagnetic fields provide fundamental data for the imaging of electrical tissue properties, such as conductivity and permittivity, in recent magnetic resonance (MR)-based tissue property mapping. The induced voltage, current density, and magnetic flux density caused by externally injected current are critical factors for determining the image quality of electrical tissue conductivity. As a useful tool to identify bio-electromagnetic phenomena, precise approaches are required to understand the exact responses inside the human body subject to an injected currents. In this study, we provide the numerical simulation results of electromagnetic field mapping of brain tissues using a MR-based conductivity imaging method. First, we implemented a realistic three-dimensional human anisotropic head model using high-resolution anatomical and diffusion tensor MR images. The voltage, current density, and magnetic flux density of brain tissues were imaged by injecting 1 mA of current through pairs of electrodes on the surface of our head model. The current density map of anisotropic brain tissues was calculated from the measured magnetic flux density based on the linear relationship between the water diffusion tensor and the electrical conductivity tensor. Comparing the current density to the previous isotropic model, the anisotropic model clearly showed the differences between the brain tissues. This originates from the enhanced signals by the inherent conductivity contrast as well as the actual tissue condition resulting from the injected currents.

  7. Transient Inverse Calibration of a Facies-Based Groundwater Flow and Transport Model Using Contaminant Concentration and Hydraulic Head Data

    NASA Astrophysics Data System (ADS)

    Williams, M. D.; Thorne, P. D.; Bergeron, M. P.; Vermeul, V. R.; Ward, D. L.

    2006-12-01

    A three dimensional groundwater flow and transport model was calibrated against observations of both hydraulic head and tritium plume concentrations measured in wells. Hydraulic parameters were estimated with a transient inverse process using UCODE, a universal inverse modeling code developed jointly by the U.S. Geological Survey and the International Groundwater Modeling Center at the Colorado School of Mines. Previous groundwater models at the site had been calibrated using hydraulic head data in the transient inverse calibration process. The resulting models were good at fitting the hydraulic head data, but did not perform well in replicating the movement of contaminant plumes over this period. A separate transient inverse calibration effort used only tritium measurements collected from wells at the site over the operational period, along with estimates of the water volume and tritium mass discharged to the aquifer, to estimate the hydraulic properties. The resulting model did a better job of replicating the overall shape and development of the tritium plume, but did not do as well in matching the hydraulic heads. Both the hydraulic head and tritium concentration data sets were used jointly in the transient inverse process for this study. These data included 47,739 measurements of hydraulic head from 543 wells and 37,802 measurements of tritium concentrations from 1,201 wells. The transient inverse process estimated hydraulic conductivity for 18 facies-based zones in the main sand and gravel units in the unconfined aquifer. A simplified weighting scheme for the hydraulic head and tritium data was developed so that the overall sum-of-squared residuals for the inverse runs were roughly equally weighted for the two data sets. Preliminary simulation results from this combined calibration dataset show a good fit for both the evolving tritium plume and hydraulic head measurements over the operational period.

  8. Cortical imaging on a head template: a simulation study using a resistor mesh model (RMM).

    PubMed

    Chauveau, Nicolas; Franceries, Xavier; Aubry, Florent; Celsis, Pierre; Rigaud, Bernard

    2008-09-01

    The T1 head template model used in Statistical Parametric Mapping Version 2000 (SPM2), was segmented into five layers (scalp, skull, CSF, grey and white matter) and implemented in 2 mm voxels. We designed a resistor mesh model (RMM), based on the finite volume method (FVM) to simulate the electrical properties of this head model along the three axes for each voxel. Then, we introduced four dipoles of high eccentricity (about 0.8) in this RMM, separately and simultaneously, to compute the potentials for two sets of conductivities. We used the direct cortical imaging technique (CIT) to recover the simulated dipoles, using 60 or 107 electrodes and with or without addition of Gaussian white noise (GWN). The use of realistic conductivities gave better CIT results than standard conductivities, lowering the blurring effect on scalp potentials and displaying more accurate position areas when CIT was applied to single dipoles. Simultaneous dipoles were less accurately localized, but good qualitative and stable quantitative results were obtained up to 5% noise level for 107 electrodes and up to 10% noise level for 60 electrodes, showing that a compromise must be found to optimize both the number of electrodes and the noise level. With the RMM defined in 2 mm voxels, the standard 128-electrode cap and 5% noise appears to be the upper limit providing reliable source positions when direct CIT is used. The admittance matrix defining the RMM is easy to modify so as to adapt to different conductivities. The next step will be the adaptation of individual real head T2 images to the RMM template and the introduction of anisotropy using diffusion imaging (DI). PMID:18629625

  9. Bisphosphonates and Osteonecrosis of the Jaw: Moving from the Bedside to the Bench

    PubMed Central

    Allen, Matthew R.

    2008-01-01

    Osteonecrosis of the jaw (ONJ) has received significant attention as a potential side effect of bisphosphonate treatment. The limited understanding of the underlying pathophysiology of the condition emphasizes the need to transition ONJ research from the bedside to the bench, supplementing ongoing clinical research with animal/basic science studies. The goal of this review is to briefly highlight the most commonly proposed mechanisms for ONJ and then summarize our laboratory's recent efforts to begin transitioning ONJ research to an animal model. Remodeling suppression, disrupted angiogenesis and infection have all been proposed to connect bisphosphonates to ONJ, although most supportive data for each of these are either indirect or nonexistent. Our laboratory has begun studying the dog as a potential model of ONJ. We have shown regions of necrotic bone matrix within the mandible of dogs treated with oral or intravenous bisphosphonate. We hypothesize these regions are the result of remodeling suppression, and if combined with additional factors such as dental intervention or infection, would result in manifestation of exposed oral lesions, the clinical definition of ONJ. Although these findings suggest the dog may be a viable animal model to study ONJ, many questions remain unanswered. No matter what animal model is found to mimic the clinical presentation of ONJ, once established it will allow significant progress toward understanding the specific role of bisphosphonates in the pathophysiology of ONJ and if/how the entity of ONJ can best be treated and prevented. PMID:18698128

  10. Mechanics of blast loading on the head models in the study of traumatic brain injury using experimental and computational approaches.

    PubMed

    Ganpule, S; Alai, A; Plougonven, E; Chandra, N

    2013-06-01

    Blast waves generated by improvised explosive devices can cause mild, moderate to severe traumatic brain injury in soldiers and civilians. To understand the interactions of blast waves on the head and brain and to identify the mechanisms of injury, compression-driven air shock tubes are extensively used in laboratory settings to simulate the field conditions. The overall goal of this effort is to understand the mechanics of blast wave-head interactions as the blast wave traverses the head/brain continuum. Toward this goal, surrogate head model is subjected to well-controlled blast wave profile in the shock tube environment, and the results are analyzed using combined experimental and numerical approaches. The validated numerical models are then used to investigate the spatiotemporal distribution of stresses and pressure in the human skull and brain. By detailing the results from a series of careful experiments and numerical simulations, this paper demonstrates that: (1) Geometry of the head governs the flow dynamics around the head which in turn determines the net mechanical load on the head. (2) Biomechanical loading of the brain is governed by direct wave transmission, structural deformations, and wave reflections from tissue-material interfaces. (3) Deformation and stress analysis of the skull and brain show that skull flexure and tissue cavitation are possible mechanisms of blast-induced traumatic brain injury. PMID:22832705

  11. NIR light propagation in a digital head model for traumatic brain injury (TBI)

    PubMed Central

    Francis, Robert; Khan, Bilal; Alexandrakis, George; Florence, James; MacFarlane, Duncan

    2015-01-01

    Near infrared spectroscopy (NIRS) is capable of detecting and monitoring acute changes in cerebral blood volume and oxygenation associated with traumatic brain injury (TBI). Wavelength selection, source-detector separation, optode density, and detector sensitivity are key design parameters that determine the imaging depth, chromophore separability, and, ultimately, clinical usefulness of a NIRS instrument. We present simulation results of NIR light propagation in a digital head model as it relates to the ability to detect intracranial hematomas and monitor the peri-hematomal tissue viability. These results inform NIRS instrument design specific to TBI diagnosis and monitoring. PMID:26417498

  12. NIR light propagation in a digital head model for traumatic brain injury (TBI).

    PubMed

    Francis, Robert; Khan, Bilal; Alexandrakis, George; Florence, James; MacFarlane, Duncan

    2015-09-01

    Near infrared spectroscopy (NIRS) is capable of detecting and monitoring acute changes in cerebral blood volume and oxygenation associated with traumatic brain injury (TBI). Wavelength selection, source-detector separation, optode density, and detector sensitivity are key design parameters that determine the imaging depth, chromophore separability, and, ultimately, clinical usefulness of a NIRS instrument. We present simulation results of NIR light propagation in a digital head model as it relates to the ability to detect intracranial hematomas and monitor the peri-hematomal tissue viability. These results inform NIRS instrument design specific to TBI diagnosis and monitoring. PMID:26417498

  13. MIDA: A Multimodal Imaging-Based Detailed Anatomical Model of the Human Head and Neck

    PubMed Central

    Iacono, Maria Ida; Neufeld, Esra; Akinnagbe, Esther; Bower, Kelsey; Wolf, Johanna; Vogiatzis Oikonomidis, Ioannis; Sharma, Deepika; Lloyd, Bryn; Wilm, Bertram J.; Wyss, Michael; Pruessmann, Klaas P.; Jakab, Andras; Makris, Nikos; Cohen, Ethan D.; Kuster, Niels; Kainz, Wolfgang; Angelone, Leonardo M.

    2015-01-01

    Computational modeling and simulations are increasingly being used to complement experimental testing for analysis of safety and efficacy of medical devices. Multiple voxel- and surface-based whole- and partial-body models have been proposed in the literature, typically with spatial resolution in the range of 1–2 mm and with 10–50 different tissue types resolved. We have developed a multimodal imaging-based detailed anatomical model of the human head and neck, named “MIDA”. The model was obtained by integrating three different magnetic resonance imaging (MRI) modalities, the parameters of which were tailored to enhance the signals of specific tissues: i) structural T1- and T2-weighted MRIs; a specific heavily T2-weighted MRI slab with high nerve contrast optimized to enhance the structures of the ear and eye; ii) magnetic resonance angiography (MRA) data to image the vasculature, and iii) diffusion tensor imaging (DTI) to obtain information on anisotropy and fiber orientation. The unique multimodal high-resolution approach allowed resolving 153 structures, including several distinct muscles, bones and skull layers, arteries and veins, nerves, as well as salivary glands. The model offers also a detailed characterization of eyes, ears, and deep brain structures. A special automatic atlas-based segmentation procedure was adopted to include a detailed map of the nuclei of the thalamus and midbrain into the head model. The suitability of the model to simulations involving different numerical methods, discretization approaches, as well as DTI-based tensorial electrical conductivity, was examined in a case-study, in which the electric field was generated by transcranial alternating current stimulation. The voxel- and the surface-based versions of the models are freely available to the scientific community. PMID:25901747

  14. Determination of stimulation focality in heterogeneous head models during transcranial magnetic stimulation (TMS)

    NASA Astrophysics Data System (ADS)

    Lee, Erik; Hadimani, Ravi; Jiles, David

    2015-03-01

    Transcranial Magnetic Stimulation (TMS) is an increasingly popular tool used by both the scientific and medical community to understand and treat the brain. TMS has the potential to help people with a wide range of diseases such as Parkinson's, Alzheimer's, and PTSD, while currently being used to treat people with chronic, drug-resistant depression. Through computer simulations, we are able to see the electric field that TMS induces in anatomical human models, but there is no measure to quantify this electric field in a way that relates to a specific patient undergoing TMS therapy. We propose a way to quantify the focality of the induced electric field in a heterogeneous head model during TMS by relating the surface area of the brain being stimulated to the total volume of the brain being stimulated. This figure would be obtained by conducting finite element analysis (FEA) simulations of TMS therapy on a patient specific head model. Using this figure to assist in TMS therapy will allow clinicians and researchers to more accurately stimulate the desired region of a patient's brain and be more equipped to do comparative studies on the effects of TMS across different patients. This work was funded by the Carver Charitable Trust.

  15. Partially Automated Method for Localizing Standardized Acupuncture Points on the Heads of Digital Human Models

    PubMed Central

    Kim, Jungdae; Kang, Dae-In

    2015-01-01

    Having modernized imaging tools for precise positioning of acupuncture points over the human body where the traditional therapeutic method is applied is essential. For that reason, we suggest a more systematic positioning method that uses X-ray computer tomographic images to precisely position acupoints. Digital Korean human data were obtained to construct three-dimensional head-skin and skull surface models of six individuals. Depending on the method used to pinpoint the positions of the acupoints, every acupoint was classified into one of three types: anatomical points, proportional points, and morphological points. A computational algorithm and procedure were developed for partial automation of the positioning. The anatomical points were selected by using the structural characteristics of the skin surface and skull. The proportional points were calculated from the positions of the anatomical points. The morphological points were also calculated by using some control points related to the connections between the source and the target models. All the acupoints on the heads of the six individual were displayed on three-dimensional computer graphical image models. This method may be helpful for developing more accurate experimental designs and for providing more quantitative volumetric methods for performing analyses in acupuncture-related research. PMID:26101534

  16. CE-QUAL-W2 Modeling of Head-of-Reservoir Conditions at Shasta Reservoir, California

    NASA Astrophysics Data System (ADS)

    Clancey, K. M.; Saito, L.; Svoboda, C.; Bender, M. D.; Hannon, J.

    2014-12-01

    Restoration of Chinook salmon and steelhead is a priority in the Sacramento River Basin since they were listed under the Endangered Species Act in 1989 and 1998, respectively. Construction of Shasta Dam and Reservoir obstructed fish migration, resulting in severe population declines. Efforts have been undertaken to restore the fisheries, including evaluation of opportunities for reintroducing Chinook salmon upstream of the dam and providing juvenile fish passage downstream past Shasta Dam. Shasta Reservoir and the Sacramento River and McCloud River tributaries have been modeled with CE-QUAL-W2 (W2) to assess hydrodynamic and temperature conditions with and without surface curtains to be deployed in the tributaries. Expected head-of-reservoir tributary conditions of temperature and water depth are being simulated under dry, median and wet year conditions. Model output is analyzed during months of downstream migration of fish from upstream Sacramento and McCloud River tributaries. W2 will be used to determine presence of favorable conditions for juvenile rearing with proposed surface temperature curtains. Evaluation of favorable conditions for fish includes assessment of water temperature, velocities, and depth. Preliminary results for head-of-reservoir conditions and the influence of temperature curtains modeled with W2 will be presented. Study findings may assist in formulation of juvenile fish passage alternatives for Shasta Lake.

  17. Impact of uncertainty description on assimilating hydraulic head in the MIKE SHE distributed hydrological model

    NASA Astrophysics Data System (ADS)

    Zhang, Donghua; Madsen, Henrik; Ridler, Marc E.; Refsgaard, Jens C.; Jensen, Karsten H.

    2015-12-01

    The ensemble Kalman filter (EnKF) is a popular data assimilation (DA) technique that has been extensively used in environmental sciences for combining complementary information from model predictions and observations. One of the major challenges in EnKF applications is the description of model uncertainty. In most hydrological EnKF applications, an ad hoc model uncertainty is defined with the aim of avoiding a collapse of the filter. The present work provides a systematic assessment of model uncertainty in DA applications based on combinations of forcing, model parameters, and state uncertainties. This is tested in a case where groundwater hydraulic heads are assimilated into a distributed and integrated catchment-scale model of the Karup catchment in Denmark. A series of synthetic data assimilation experiments are carried out to analyse the impact of different model uncertainty assumptions on the feasibility and efficiency of the assimilation. The synthetic data used in the assimilation study makes it possible to diagnose model uncertainty assumptions statistically. Besides the model uncertainty, other factors such as observation error, observation locations, and ensemble size are also analysed with respect to performance and sensitivity. Results show that inappropriate definition of model uncertainty can greatly degrade the assimilation performance, and an appropriate combination of different model uncertainty sources is advised.

  18. Study of the influence of the laterality of mobile phone use on the SAR induced in two head models

    NASA Astrophysics Data System (ADS)

    Ghanmi, Amal; Varsier, Nadège; Hadjem, Abdelhamid; Conil, Emmanuelle; Picon, Odile; Wiart, Joe

    2013-05-01

    The objective of this paper is to investigate and to analyse the influence of the laterality of mobile phone use on the exposure of the brain to radio-frequencies (RF) and electromagnetic fields (EMF) from different mobile phone models using the finite-difference time-domain (FDTD) method. The study focuses on the comparison of the specific absorption rate (SAR) induced on the right and left sides of two numerical adult and child head models. The heads are exposed by both phone models operating in GSM frequency bands for both ipsilateral and contralateral configurations. A slight SAR difference between the two sides of the heads is noted. The results show that the variation between the left and the right sides is more important at 1800 MHz for an ipsilateral use. Indeed, at this frequency, the variation can even reach 20% for the SAR10g and the SAR1g induced in the head and in the brain, respectively. Moreover, the average SAR induced by the mobile phone in the half hemisphere of the brain in ipsilateral exposure is higher than in contralateral exposure. Owing to the superficial character of energy deposition at 1800 MHz, this difference in the SAR induced for the ipsilateral and contralateral usages is more significant at 1800 MHz than at 900 MHz. The results have shown that depending on the phantom head models, the SAR distribution in the brain can vary because of differences in anatomical proportions and in the geometry of the head models. The induced SAR in child head and in sub-regions of the brain is significantly higher (up to 30%) compared to the adult head. This paper confirms also that the shape/design of the mobile and the location of the antenna can have a large influence at high frequency on the exposure of the brain, particularly on the SAR distribution and on the distinguished brain regions.

  19. Modeling and Individualization of Head-Related Transfer Functions Using Principal Component Analysis

    NASA Astrophysics Data System (ADS)

    Fink, Kimberly J.

    Spatial localization of sound depends on interaural time delay (ITD), level difference, and on the interaction of the source with the head, torso, and pinna. Head-related transfer functions (HRTFs) model the dynamics that are used by listeners to derive spatial information from binaural signals and are used to create virtual auditory displays (VADs). This thesis presents methods to model and customize HRTFs for the creation of a tunable VAD. Prior research has investigated development of virtual auditory displays (VADs) using models of HRTFs as a function of a finite number of principal components (PCs) and associated weights (PCWs). This thesis investigates the effect of PCWs on horizontal plane HRTFs derived from a database of head-related impulse responses (HRIRs). Tuning is evaluated from a numerical perspective to determine how variation of PCWs from an average PC model affects HRTF spectral characteristics. A PC model of an average subject at 50 azimuths in the horizontal plane is developed from HRIRs of 34 subjects from a public database. An additional nine subjects are used to test the PC model and conduct three optimization experiments, in which a cost function of spectral distortion is minimized by sequentially tuning PCWs. These experiments show that error deriving from PC model truncation can be reduced and average HRTFs can be tuned to match individual HRTFs. Model order reduction is used to reduce the dimensionality of a VAD from 200 point FIR filters for each ear to 15th order IIR filters per ear, without introducing audible differences. Subject testing evaluated the performance of the tuning. First the subject listens to a known azimuth and tunes sliders related to the PCWs and ITD so that what they are hearing sound like the given azimuth. On a later day, azimuths are presented in a random order unknown to the subject and he or she is asked to make judgments about where they perceive the sound. The tuned PCWs are interpolated to obtain customized

  20. Coupled head neck torso and seat model for car seat optimization under rear-end impact

    NASA Astrophysics Data System (ADS)

    Bourdet, Nicolas; Willinger, Rémy

    2008-06-01

    The development of new protective systems must be performed on tools reliable and representative of alive human. In an earlier study, a simplified but realistic modelling of the head-neck system under moderate rear impact was performed. In order to address this issue, an original lumped model of the human torso was developed and coupled to a car seat-head rest complex. The experimental modal analysis of the human torso in a seating position performed by Kitazaki in 1992 [Paper presented at the United Kingdom Meeting on Human Response to Vibration held at I.S.V.R. University of Southampton, Southampton, UK, 28-30 September 1992.] was used in the present study for the identification of the mechanical parameters of a lumped human torso model. Despite its low complexity, this model was able to reproduce the five first experimental vibration modes and it was possible to validate it in terms of natural frequencies, damping ratio and mode shapes. In addition to the lumped approach, an external geometry of the human torso was implemented in order to provide a realistic coupling of the human body model to a finite element model of the car seat also developed in the present study. A parametric study was finally carried out in order to evaluate the influence of the torso behaviour and of the different parts of a car seat on the mechanical neck response under rear-end impact. The results of this study allow concluding that the torso behaviour has an important influence on the neck loading and therefore that the quality of a car seat depends on the human body substitute used. For instance, with the proposed torso model, a low-neck injury criterion (NIC) rearward value was obtained with low rigidity of the backrest foam and a stiff backrest net.

  1. EEG source analysis of epileptiform activity using a 1mm anisotropic hexahedra finite element head model

    PubMed Central

    Rullmann, M.; Anwander, A.; Dannhauer, M.; Warfield, S.K.; Duffy, F.H.; Wolters, C.H.

    2009-01-01

    The major goal of the evaluation in presurgical epilepsy diagnosis for medically intractable patients is the precise reconstruction of the epileptogenic foci, preferably with non-invasive methods. This paper evaluates whether surface electroencephalography (EEG) source analysis based on a 1mm anisotropic finite element (FE) head model can provide additional guidance for presurgical epilepsy diagnosis and whether it is practically feasible in daily routine. A 1mm hexahedra FE volume conductor model of the patient’s head with special focus on accurately modeling the compartments skull, cerebrospinal fluid (CSF) and the anisotropic conducting brain tissues was constructed using non-linearly co-registered T1-, T2- and diffusion-tensor- magnetic resonance imaging data. The electrodes of intra-cranial EEG (iEEG) measurements were extracted from a co-registered computed tomography image. Goal function scan (GFS), minimum norm least squares (MNLS), standardized low resolution electromagnetic tomography (sLORETA) and spatio-temporal current dipole modeling inverse methods were then applied to the peak of the averaged ictal discharges EEG data. MNLS and sLORETA pointed to a single center of activity. Moving and rotating single dipole fits resulted in an explained variance of more than 97%. The non-invasive EEG source analysis methods localized at the border of the lesion and at the border of the iEEG electrodes which mainly received ictal discharges. Source orientation was towards the epileptogenic tissue. For the reconstructed superficial source, brain conductivity anisotropy and the lesion conductivity had only a minor influence, whereas a correct modeling of the highly conducting CSF compartment and the anisotropic skull was found to be important. The proposed FE forward modeling approach strongly simplifies meshing and reduces run-time (37 Milliseconds for one forward computation in the model with 3.1 Million unknowns), corroborating the practical feasibility of the

  2. Multicamera 3D modeling system to digitize human head and body

    NASA Astrophysics Data System (ADS)

    Fujimura, Kouta; Matsumoto, Yukinori; Emi, Tetsuichi

    2001-04-01

    A multi-camera 3D modeling system to digitize a human head and body is presented in this paper. The main features of this system are as follows: 1) Fast capturing: Both of texture images and pattern images can be taken within a few seconds using multiple digital still cameras which are set around the target human. Slide projectors are also set to provide a color line patterned light on the target for pattern image capturing, 2) Realistic Shape and Texture: The whole shape and photo-realistic textures of the human head including hair can be digitized at a time on a personal computer, and 3) Hybrid Algorithm: Our modeling algorithm is based on a hybrid method where the Shape-from-Silhouette technique and the Active-Stereo technique are combined. In the first step, the rough shape of the target is estimated in a voxel space using our Extended Shape-from-Silhouette method. In the next step, the shape is refined based on the depth-map data that is calculated using a multi-camera active stereo method. This combination makes up for the shortcomings of each method. Our system has been applied to the digitizing several Japanese people using sixteen cameras for texture image capturing and twelve cameras and two projectors for pattern image capturing. Its capturing time is approximately three seconds and calculation time is about 15-20 minutes on a personal computer with the Pentium-III processor (600MHz) and 512MB memory to digitize the whole shape as well as the texture of the human head and body.

  3. Biofidelic white matter heterogeneity decreases computational model predictions of white matter strains during rapid head rotations.

    PubMed

    Maltese, Matthew R; Margulies, Susan S

    2016-11-01

    The finite element (FE) brain model is used increasingly as a design tool for developing technology to mitigate traumatic brain injury. We developed an ultra high-definition FE brain model (>4 million elements) from CT and MRI scans of a 2-month-old pre-adolescent piglet brain, and simulated rapid head rotations. Strain distributions in the thalamus, coronal radiata, corpus callosum, cerebral cortex gray matter, brainstem and cerebellum were evaluated to determine the influence of employing homogeneous brain moduli, or distinct experimentally derived gray and white matter property representations, where some white matter regions are stiffer and others less stiff than gray matter. We find that constitutive heterogeneity significantly lowers white matter deformations in all regions compared with homogeneous properties, and should be incorporated in FE model injury prediction. PMID:27123826

  4. Effect of Head Position on Cerebrospinal Fluid Pressure in Cats: Comparison with Artificial Model

    PubMed Central

    Klarica, Marijan; Radoš, Milan; Draganić, Pero; Erceg, Gorislav; Orešković, Darko; Maraković, Jurica; Bulat, Marin

    2006-01-01

    Aim To demonstrate that changes in the cerebrospinal fluid (CSF) pressure in the cranial cavity and spinal canal after head elevation from the horizontal level occur primarily due to the biophysical characteristics of the CSF system, ie, distensibility of the spinal dura. Methods Experiments in vivo were performed on cats and a new artificial model of the CSF system with dimensions similar to the CSF system in cats, consisting of non-distensible cranial and distensible spinal part. Measurements of the CSF pressure in the cranial and spinal spaces were performed in chloralose-anesthetized cats (n = 10) in the horizontal position on the base of a stereotaxic apparatus (reference zero point) and in the position in which the head was elevated to 5 cm and 10 cm above that horizontal position. Changes in the CSF pressure in the cranial and spinal part of the model were measured in the cranial part positioned in the same way as the head in cats (n = 5). Results When the cat was in the horizontal position, the values of the CSF pressure in the cranial (11.9 ± 1.1 cm H2O) and spinal (11.8 ± 0.6 cm H2O) space were not significantly different. When the head was elevated 5 cm or 10 cm above the reference zero point, the CSF pressure in the cranium significantly decreased to 7.7 ± 0.6 cm H2O and 4.7 ± 0.7 cm H2O, respectively, while the CSF pressure in the spinal space significantly increased to 13.8 ± 0.7 cm H2O and 18.5 ± 1.6 cm H2O, respectively (P<0.001 for both). When the artificial CSF model was positioned in the horizontal level and its cranial part elevated by 5 cm and 10 cm, the changes in the pressure were the same as those in the cats when in the same hydrostatic position. Conclusions The new model of the CSF system used in our study faithfully mimicked the changes in the CSF pressure in cats during head elevation in relation to the body. Changes in the pressure in the model were not accompanied by the changes in fluid volume in

  5. Estimation of electrical conductivity of a layered spherical head model using electrical impedance tomography

    NASA Astrophysics Data System (ADS)

    Fernández-Corazza, M.; von-Ellenrieder, N.; Muravchik, C. H.

    2011-12-01

    Electrical Impedance Tomography (EIT) is a non-invasive method that aims to create an electrical conductivity map of a volume. In particular, it can be applied to study the human head. The method consists on the injection of an unperceptive and known current through two electrodes attached to the scalp, and the measurement of the resulting electric potential distribution at an array of sensors also placed on the scalp. In this work, we propose a parametric estimation of the brain, scalp and skull conductivities using EIT over an spherical model of the head. The forward problem involves the computation of the electric potential on the surface, for given the conductivities and the injection electrode positions, while the inverse problem consists on estimating the conductivities given the sensor measurements. In this study, the analytical solution to the forward problem based on a three layer spherical model is first described. Then, some measurements are simulated adding white noise to the solutions and the inverse problem is solved in order to estimate the brain, skull and scalp conductivity relations. This is done with a least squares approach and the Nelder-Mead multidimensional unconstrained nonlinear minimization method.

  6. Monte Carlo modeling of light propagation in the human head for applications in sinus imaging

    NASA Astrophysics Data System (ADS)

    Cerussi, Albert E.; Mishra, Nikhil; You, Joon; Bhandarkar, Naveen; Wong, Brian J. F.

    2015-02-01

    Sinus blockages are a common reason for physician visits, affecting 1 out of 7 in the United States. Over 20 million cases of acute bacterial sinusitis become chronic and require medical treatment. Diagnosis in the primary care setting is challenging because symptom criteria (via detailed clinical history) plus objective imaging (CT or endoscopy) is recommended. Unfortunately, neither option is routinely available in primary care. Our previous work demonstrated that low-cost near infrared (NIR) transillumination instruments produced signals that correlated with the bulk findings of sinus opacity measured by CT. We have upgraded the technology, but questions remain such as finding the optimal arrangement of light sources, measuring the influence of specific anatomical structures, and determining detection limits. In order to begin addressing these questions, we have modeled NIR light propagation inside the adult human head using a mesh-based Monte Carlo algorithm (MMCLab) applied to a detailed anatomical head model constructed from CT images. In this application the sinus itself, which under healthy conditions is a void region (e.g., non-scattering), is the region of interest instead of an obstacle to other contrast mechanisms. We report preliminary simulations that characterize the changes in detected intensity due to clear (i.e., healthy) versus blocked sinuses. We also ran simulations for two of our clinical cases and compared results with the measurements. The simulations presented herein serve as a proof of concept that this approach could be used to understand contrast mechanisms and limitations of NIR imaging of the sinus cavities.

  7. Efficiency prediction for a low head bulb turbine with SAS SST and zonal LES turbulence models

    NASA Astrophysics Data System (ADS)

    Jošt, D.; Škerlavaj, A.

    2014-03-01

    A comparison between results of numerical simulations and measurements for a 3-blade bulb turbine is presented in order to determine an appropriate numerical setup for accurate and reliable simulations of flow in low head turbines. Numerical analysis was done for three angles of runner blades at two values of head. For the smallest blade angle the efficiency was quite accurately predicted, but for the optimal and maximal blade angles steady state analysis entirely failed to predict the efficiency due to underestimated torque on the shaft and incorrect results in the draft tube. Transient simulation with SST did not give satisfactory results, but with SAS and zonal LES models the prediction of efficiency was significantly improved. From the results obtained by SAS and zonal LES the interdependence between turbulence models, vortex structures in the flow, values of eddy viscosity and flow energy losses in the draft tube can be seen. Also the effect of using the bounded central differential scheme instead of the high resolution scheme was evident. To test the effect of grid density, simulations were performed on four grids. While a difference between results obtained on the basic grid and on the fine grid was small, the results obtained on the coarse grids were not satisfactory.

  8. Safety and efficacy of quadrapeutics versus chemoradiation in head and neck carcinoma xenograft model.

    PubMed

    Lukianova-Hleb, Ekaterina Y; Kim, Yoo-Shin; Aryasomayajula, Bhawani; Boulikas, Teni; Phan, Jack; Hung, Mien-Chie; Torchilin, Vladimir P; O'Neill, Brian E; Lapotko, Dmitri O

    2015-01-01

    Chemoradiation is the strongest anti-tumor therapy but in resistant unresectable cancers it often lacks safety and efficacy. We compared our recently developed cell-level combination approach, quadrapeutics, to chemoradiation therapy to establish pre-clinical data for its biodistribution, safety and efficacy in head and neck squamous cell carcinoma (HNSCC), as a clinically challenging aggressive and resistant cancer. In vitro and in vivo models of four carcinomas were treated with standard chemoradiation and quadrapeutics using identical drug and radiation doses. We applied liposomal cisplatin or doxorubicin, colloidal gold, near-infrared laser pulses and radiation, all at low safe doses. The final evaluation used a xenograft model of HNSCC. Quadrapeutics enhanced standard chemoradiation in vitro by reducing head and neck cancer cell proliferation by 1000-fold, inhibiting tumor growth in vivo by 34-fold and improving animal survival by 5-fold, and reducing the side effects to a negligible level. In quadrapeutics, we observed an "inversion" of the drug efficacy of two standard drugs: doxorubicin, a low efficacy drug for the cancers studied, was two times more efficient than cisplatin, the first choice drug in clinic for HNSCC. The radical therapeutic gain of quadrapeutics resulted from the intracellular synergy of the four components employed which we administered in a specific sequence, while the reduction in the toxicity was due to the low doses of all four components. The biodistribution, safety and efficacy data for quadrapeutics in HNSCC ensure its high translational potential and justify the possibility of clinical trials. PMID:26885444

  9. Safety and efficacy of quadrapeutics versus chemoradiation in head and neck carcinoma xenograft model

    PubMed Central

    Lukianova-Hleb, Ekaterina Y; Kim, Yoo-Shin; Aryasomayajula, Bhawani; Boulikas, Teni; Phan, Jack; Hung, Mien-Chie; Torchilin, Vladimir P; O’Neill, Brian E; Lapotko, Dmitri O

    2015-01-01

    Chemoradiation is the strongest anti-tumor therapy but in resistant unresectable cancers it often lacks safety and efficacy. We compared our recently developed cell-level combination approach, quadrapeutics, to chemoradiation therapy to establish pre-clinical data for its biodistribution, safety and efficacy in head and neck squamous cell carcinoma (HNSCC), as a clinically challenging aggressive and resistant cancer. In vitro and in vivo models of four carcinomas were treated with standard chemoradiation and quadrapeutics using identical drug and radiation doses. We applied liposomal cisplatin or doxorubicin, colloidal gold, near-infrared laser pulses and radiation, all at low safe doses. The final evaluation used a xenograft model of HNSCC. Quadrapeutics enhanced standard chemoradiation in vitro by reducing head and neck cancer cell proliferation by 1000-fold, inhibiting tumor growth in vivo by 34-fold and improving animal survival by 5-fold, and reducing the side effects to a negligible level. In quadrapeutics, we observed an “inversion” of the drug efficacy of two standard drugs: doxorubicin, a low efficacy drug for the cancers studied, was two times more efficient than cisplatin, the first choice drug in clinic for HNSCC. The radical therapeutic gain of quadrapeutics resulted from the intracellular synergy of the four components employed which we administered in a specific sequence, while the reduction in the toxicity was due to the low doses of all four components. The biodistribution, safety and efficacy data for quadrapeutics in HNSCC ensure its high translational potential and justify the possibility of clinical trials. PMID:26885444

  10. Development of the software tool for generation and visualization of the finite element head model with bone conduction sounds

    NASA Astrophysics Data System (ADS)

    Nikolić, Dalibor; Milošević, Žarko; Saveljić, Igor; Filipović, Nenad

    2015-12-01

    Vibration of the skull causes a hearing sensation. We call it Bone Conduction (BC) sound. There are several investigations about transmission properties of bone conducted sound. The aim of this study was to develop a software tool for easy generation of the finite element (FE) model of the human head with different materials based on human head anatomy and to calculate sound conduction through the head. Developed software tool generates a model in a few steps. The first step is to do segmentation of CT medical images (DICOM) and to generate a surface mesh files (STL). Each STL file presents a different layer of human head with different material properties (brain, CSF, different layers of the skull bone, skin, etc.). The next steps are to make tetrahedral mesh from obtained STL files, to define FE model boundary conditions and to solve FE equations. This tool uses PAK solver, which is the open source software implemented in SIFEM FP7 project, for calculations of the head vibration. Purpose of this tool is to show impact of the bone conduction sound of the head on the hearing system and to estimate matching of obtained results with experimental measurements.

  11. Multistate Models for Estimation of Survival and Reproduction in the Grey-headed Albatross (Thalassarche chrysostoma)

    USGS Publications Warehouse

    Converse, S.J.; Kendall, W.L.; Doherty, P.F., Jr.; Ryan, P.G.

    2009-01-01

    Reliable information on demography is necessary for conservation of albatrosses, the most threatened family of pelagic birds. Albatross survival has been estimated using mark?recapture data and the Cormack-Jolly-Seber (CJS) model. However, albatross exhibit skipped breeding, violating assumptions of the CJS model. Multistate modeling integrating unobservable states is a promising tool for such situations. We applied multistate models to data on Grey-headed Albatross (Thalassarche chrysostoma) to evaluate model performance and describe demographic patterns. These included a multistate equivalent of the CJS model (MS-2), including successful and failed breeding states and ignoring temporary emigration, and three versions of a four-state multistate model that accounts for temporary emigration by integrating unobservable states: a model (MS-4) with one sample per breeding season, a robust design model (RDMS-4) with multiple samples per season and geographic closure within the season, and an open robust design model (ORDMS-4) with multiple samples per season and staggered entry and exit of animals within the season. Survival estimates from the MS-2 model were higher than those from the MS-4 model, which resulted in apparent percent relative bias averaging 2.2%. The ORDMS-4 model was more appropriate than the RDMS-4 model, given that staggered entry and exit occurred. Annual survival probability for Greyheaded Albatross at Marion Island was 0.951 ? 0.006 (SE), and the probability of skipped breeding in a subsequent year averaged 0.938 for successful and 0.163 for failed breeders. We recommend that multistate models with unobservable states, combined with robust-design sampling, be used in studies of species that exhibit temporary emigration.

  12. Alendronate-associated osteonecrosis of the jaws: A review of the main topics

    PubMed Central

    Paiva-Fonseca, Felipe; Santos-Silva, Alan R.; Della-Coletta, Ricardo; Vargas, Pablo A.

    2014-01-01

    Bisphosphonates is a group of inorganic pyrophosphates analogues that suppress bone resorption by inducing osteoclast inactivation, being frequently used for management of diseases affecting bone metabolism, bone metastases and bone tumors. However, since 2003 many cases describing the presence of necrotic bone exposures in the jaws have been described in patients receiving these drugs, what represent a significant complication of bisphosphonates treatment. The overall incidence of bisphosphonate-related osteonecrosis of the jaws is low, ranging from 0.7% to 12%, mainly observed in those patients receiving intravenously treatment. Osteonecrosis of the jaws associated to oral bisphosphonate, particularly alendronate, has also been reported by a number of authors. Considering that alendronate is one of the most used drugs worldwide, specially for treatment of osteoporosis, a better understanding of osteonecrosis of the jaws related to its use and how to manage these patients is extremely important. Therefore, in the current manuscript the authors aim to review the most important topics related to this pathological presentation. Key words:Bisphosphonates, alendronate, bisphosphonate-related osteonecrosis of the jaws, osteonecrosis. PMID:23986020

  13. Osteonecrosis of the Jaw in Patients Receiving Bone-Targeted Therapies: An Overview--Part I.

    PubMed

    Turner, Bruce; Drudge-Coates, Lawrence; Ali, Sacha; Pati, Jhumur; Nargund, Vinod; Ali, Enamul; Cheng, Leo; Wells, Paula

    2016-01-01

    Urologic patients receiving bone-targeted therapies are at risk of developing osteonecrosis of the jaw (ONJ). ONJ has historically been associated with bisphosphonate therapy. More recently, RANK-Ligand inhibitors (denosumab) have also been used to reduce the risk of skeletal-related events in patients who have advanced cancers with bone metastases. More than 65% of men with metastatic prostate cancer and nearly 75% of women with metastatic breast cancer are affected by bone metastases. The literature has described ONJ associated with bisphosphonate therapy as bisphosphonate-related osteonecrosis of the jaw (BRONJ). However, with evidence also linking the use of RANK-Ligand inhibitors with osteonecrosis of the jaw, we advocate use of the term "anti-bone resorption therapy-related osteonecrosis of the jaw" (ABRT-ONJ). The term "medication-related osteonecrosis of the jaw" (MRONJ) is now becoming more widespread. There is not a universally accepted definition of ABRT-ONJ, which may have hindered recognition and reporting of the condition. In Part I of this article, a review of current knowledge around the etiology of ABRT-ONJ and incidence data are provided. In Part II, we provide an audit of ONJ in a nurse consultant-led bone support clinic. In the article, we refer to zoledronic acid because this is the bisphosphonate of choice for use in men with prostate cancer in the United Kingdom. PMID:27501591

  14. Efficient Monte Carlo modelling of individual tumour cell propagation for hypoxic head and neck cancer

    NASA Astrophysics Data System (ADS)

    Tuckwell, W.; Bezak, E.; Yeoh, E.; Marcu, L.

    2008-09-01

    A Monte Carlo tumour model has been developed to simulate tumour cell propagation for head and neck squamous cell carcinoma. The model aims to eventually provide a radiobiological tool for radiation oncology clinicians to plan patient treatment schedules based on properties of the individual tumour. The inclusion of an oxygen distribution amongst the tumour cells enables the model to incorporate hypoxia and other associated parameters, which affect tumour growth. The object oriented program FORTRAN 95 has been used to create the model algorithm, with Monte Carlo methods being employed to randomly assign many of the cell parameters from probability distributions. Hypoxia has been implemented through random assignment of partial oxygen pressure values to individual cells during tumour growth, based on in vivo Eppendorf probe experimental data. The accumulation of up to 10 million virtual tumour cells in 15 min of computer running time has been achieved. The stem cell percentage and the degree of hypoxia are the parameters which most influence the final tumour growth rate. For a tumour with a doubling time of 40 days, the final stem cell percentage is approximately 1% of the total cell population. The effect of hypoxia on the tumour growth rate is significant. Using a hypoxia induced cell quiescence limit which affects 50% of cells with and oxygen levels less than 1 mm Hg, the tumour doubling time increases to over 200 days and the time of tumour growth for a clinically detectable tumour (109 cells) increases from 3 to 8 years. A biologically plausible Monte Carlo model of hypoxic head and neck squamous cell carcinoma tumour growth has been developed for real time assessment of the effects of multiple biological parameters which impact upon the response of the individual patient to fractionated radiotherapy.

  15. Efficient Monte Carlo modelling of individual tumour cell propagation for hypoxic head and neck cancer.

    PubMed

    Tuckwell, W; Bezak, E; Yeoh, E; Marcu, L

    2008-09-01

    A Monte Carlo tumour model has been developed to simulate tumour cell propagation for head and neck squamous cell carcinoma. The model aims to eventually provide a radiobiological tool for radiation oncology clinicians to plan patient treatment schedules based on properties of the individual tumour. The inclusion of an oxygen distribution amongst the tumour cells enables the model to incorporate hypoxia and other associated parameters, which affect tumour growth. The object oriented program FORTRAN 95 has been used to create the model algorithm, with Monte Carlo methods being employed to randomly assign many of the cell parameters from probability distributions. Hypoxia has been implemented through random assignment of partial oxygen pressure values to individual cells during tumour growth, based on in vivo Eppendorf probe experimental data. The accumulation of up to 10 million virtual tumour cells in 15 min of computer running time has been achieved. The stem cell percentage and the degree of hypoxia are the parameters which most influence the final tumour growth rate. For a tumour with a doubling time of 40 days, the final stem cell percentage is approximately 1% of the total cell population. The effect of hypoxia on the tumour growth rate is significant. Using a hypoxia induced cell quiescence limit which affects 50% of cells with and oxygen levels less than 1 mm Hg, the tumour doubling time increases to over 200 days and the time of tumour growth for a clinically detectable tumour (10(9) cells) increases from 3 to 8 years. A biologically plausible Monte Carlo model of hypoxic head and neck squamous cell carcinoma tumour growth has been developed for real time assessment of the effects of multiple biological parameters which impact upon the response of the individual patient to fractionated radiotherapy. PMID:18677039

  16. Comparison of Snyder Head Phantom Models Used for Neutron Capture Therapy Benchmark Monte Carlo Dosimetry Calculations

    NASA Astrophysics Data System (ADS)

    Goorley, T.; Kiger, W. S.; Zamenhof, R.

    As Boron Neutron Capture Therapy (BNCT) clinical trials are initiated in more countries, new treatment planning software programs are being developed to calculate dose distributions in patient specific models. A reference suite of test problems, i.e., head phantom irradiations and resulting depth-dose curves, would allow quantitative comparison of the treatment planning software. This paper presents sets of central axis depth vs. dose curves calculated with the Monte Carlo radiation transport code MCNP4B for five different representations of the Snyder head phantom. The first is a multi-shell analytic ellipsoidal representation, and the remaining four are voxelized representations with cube edge lengths of 16, 10, 8 and 4 mm. For these calculations, 10 cm diameter monoenergetic and monodirectional neutron and photon beams were incident along the central axes of the models. Individual beams of 0.0253 eV, 1, 2, 10, 100 and 1000 keV neutrons, and 0.2, 0.5, 1, 2, 5, and 10 MeV photons were simulated to high statistical convergence, with statistical error less than 1% in the center of the model. A "generic" epithermal neutron beam, with 1% fast flux contamination and 10% thermal flux contamination, similar to those proposed for BNCT treatments, was also simulated with all five models. Computations for both of the smaller sized voxel models produced thermal neutron, fast neutron, and gamma dose rates within 4% of those from the analytical representation. It is proposed that these data sets be used by the BNCT community for the verification of existing and new BNCT treatment planning software.

  17. Experimental study of blast-induced traumatic brain injury using a physical head model.

    PubMed

    Zhang, Jiangyue; Pintar, Frank A; Yoganandan, Narayan; Gennarelli, Thomas A; Son, Steven F

    2009-11-01

    This study was conducted to quantify intracranial biomechanical responses and external blast overpressures using physical head model to understand the biomechanics of blast traumatic brain injury and to provide experimental data for computer simulation of blast-induced brain trauma. Ellipsoidal-shaped physical head models, made from 3-mm polycarbonate shell filled with Sylgard 527 silicon gel, were used. Six blast tests were conducted in frontal, side, and 45 degrees oblique orientations. External blast overpressures and internal pressures were quantified with ballistic pressure sensors. Blast overpressures, ranging from 129.5 kPa to 769.3 kPa, were generated using a rigid cannon and 1.3 to 3.0 grams of pentaerythritol tetranitrate (PETN) plastic sheet explosive (explosive yield of 13.24 kJ and TNT equivalent mass of 2.87 grams for 3 grams of material). The PETN plastic sheet explosive consisted of 63% PETN powder, 29% plasticizer, and 8% nitrocellulose with a density of 1.48 g/cm3 and detonation velocity of 6.8 km/s. Propagation and reflection of the shockwave was captured using a shadowgraph technique. Shockwave speeds ranging from 423.3 m/s to 680.3 m/s were recorded. The model demonstrated a two-stage response: a pressure dominant (overpressure) stage followed by kinematic dominant (blast wind) stage. Positive pressures in the brain simulant ranged from 75.1 kPa to 1095 kPa, and negative pressures ranged from -43.6 kPa to -646.0 kPa. High- and normal-speed videos did not reveal observable deformations in the brain simulant from the neutral density markers embedded in the midsagittal plane of the head model. Amplitudes of the internal positive and negative pressures were found to linearly correlate with external overpressure. Results from the current study suggested a pressure-dominant brain injury mechanism instead of strain injury mechanism under the blast severity of the current study. These quantitative results also served as the validation and calibration

  18. Anatomical Reproducibility of a Head Model Molded by a Three-dimensional Printer

    PubMed Central

    KONDO, Kosuke; NEMOTO, Masaaki; MASUDA, Hiroyuki; OKONOGI, Shinichi; NOMOTO, Jun; HARADA, Naoyuki; SUGO, Nobuo; MIYAZAKI, Chikao

    We prepared rapid prototyping models of heads with unruptured cerebral aneurysm based on image data of computed tomography angiography (CTA) using a three-dimensional (3D) printer. The objective of this study was to evaluate the anatomical reproducibility and accuracy of these models by comparison with the CTA images on a monitor. The subjects were 22 patients with unruptured cerebral aneurysm who underwent preoperative CTA. Reproducibility of the microsurgical anatomy of skull bone and arteries, the length and thickness of the main arteries, and the size of cerebral aneurysm were compared between the CTA image and rapid prototyping model. The microsurgical anatomy and arteries were favorably reproduced, apart from a few minute regions, in the rapid prototyping models. No significant difference was noted in the measured lengths of the main arteries between the CTA image and rapid prototyping model, but errors were noted in their thickness (p < 0.001). A significant difference was also noted in the longitudinal diameter of the cerebral aneurysm (p < 0.01). Regarding the CTA image as the gold standard, reproducibility of the microsurgical anatomy of skull bone and main arteries was favorable in the rapid prototyping models prepared using a 3D printer. It was concluded that these models are useful tools for neurosurgical simulation. The thickness of the main arteries and size of cerebral aneurysm should be comprehensively judged including other neuroimaging in consideration of errors. PMID:26119896

  19. Temporal MRI characterization, neurobiochemical and neurobehavioral changes in a mouse repetitive concussive head injury model

    PubMed Central

    Yang, Zhihui; Wang, Ping; Morgan, Drake; Lin, Dan; Pan, Jianchun; Lin, Fan; Strang, Kevin H.; Selig, Tyler M.; Perez, Pablo D.; Febo, Marcelo; Chang, Binggong; Rubenstein, Richard; Wang, Kevin K.W.

    2015-01-01

    Single and repeated sports-related mild traumatic brain injury (mTBI), also referred to as concussion, can result in chronic post-concussive syndrome (PCS), neuropsychological and cognitive deficits, or chronic traumatic encephalopathy (CTE). However PCS is often difficult to diagnose using routine clinical, neuroimaging or laboratory evaluations, while CTE currently only can be definitively diagnosed postmortem. We sought to develop an animal model to simulate human repetitive concussive head injury for systematic study. In this study, mice received single or multiple head impacts by a stereotaxic impact device with a custom-made rubber tip-fitted impactor. Dynamic changes in MRI, neurobiochemical markers (Tau hyperphosphorylation and glia activation in brain tissues) and neurobehavioral functions such as anxiety, depression, motor function and cognitive function at various acute/subacute (1-7 day post-injury) and chronic (14-60 days post-injury) time points were examined. To explore the potential biomarkers of rCHI, serum levels of total Tau (T-Tau) and phosphorylated Tau (P-Tau) were also monitored at various time points. Our results show temporal dynamics of MRI consistent with structural perturbation in the acute phase and neurobiochemical changes (P-Tau and GFAP induction) in the subacute and chronic phase as well as development of chronic neurobehavioral changes, which resemble those observed in mTBI patients. PMID:26058556

  20. SCDAP/RELAP5 Modeling of Movement of Melted Material through Porous Debris in Lower Head (Rev. 2)

    SciTech Connect

    Siefken, Larry James

    1999-10-01

    A model is described for the movement of melted metallic material through a ceramic porous debris bed. The model is designed for the analysis of severe accidents in LWRs, wherein melted core plate material may slump onto the top of a porous bed of relocated core material supported by the lower head. The permeation of the melted core plate material into the porous debris bed influences the heatup of the debris bed and the heatup of the lower head supporting the debris. A model for mass transport of melted metallic material is applied that includes terms for viscosity and turbulence but neglects inertial and capillary terms because of their small value relative to gravity and viscous terms in the momentum equation. The relative permeability and passability of the porous debris are calculated as functions of debris porosity, particle size, and effective saturation. An iterative numerical solution is used to solve the set of nonlinear equations for mass transport. The effective thermal conductivity of the debris is calculated as a function of porosity, particle size, and saturation. The model integrates the equations for mass transport with a model for the two-dimensional conduction of heat through porous debris. The integrated model has been implemented into the SCDAP/RELAP5 code for the analysis of the integrity of LWR lower heads during severe accidents. The results of the model indicate that melted core plate material my permeate in about 120 s to the bottom of a 1 m deep hot porous debris bed supported by the lower head. The presence of the relocated core plate material at the bottom of the debris bed decreases the thermal resistance of the interface between the debris bed and the lower head. This report is a revision of the report with the identifier of INEEL/EXT-98-01178 REV 1, entitled "SCDAP/RELAP5 Modeling of Movement of Melted Material Through Porous Debris in Lower Head."

  1. Vascular endothelial growth factor/bone morphogenetic protein-2 bone marrow combined modification of the mesenchymal stem cells to repair the avascular necrosis of the femoral head

    PubMed Central

    Ma, Xiao-Wei; Cui, Da-Ping; Zhao, De-Wei

    2015-01-01

    Vascular endothelial cell growth factor (VEGF) combined with bone morphogenetic protein (BMP) was used to repair avascular necrosis of the femoral head, which can maintain the osteogenic phenotype of seed cells, and effectively secrete VEGF and BMP-2, and effectively promote blood vessel regeneration and contribute to formation and revascularization of tissue engineered bone tissues. To observe the therapeutic effect on the treatment of avascular necrosis of the femoral head by using bone marrow mesenchymal stem cells (BMSCs) modified by VEGF-165 and BMP-2 in vitro. The models were avascular necrosis of femoral head of rabbits on right leg. There groups were single core decompression group, core decompression + BMSCs group, core decompression + VEGF-165/BMP-2 transfect BMSCs group. Necrotic bone was cleared out under arthroscope. Arthroscopic observation demonstrated that necrotic bone was cleared out in each group, and fresh blood flowed out. Histomorphology determination showed that blood vessel number and new bone area in the repair region were significantly greater at various time points following transplantation in the core decompression + VEGF-165/BMP-2 transfect BMSCs group compared with single core decompression group and core decompression + BMSCs group (P < 0.05). These suggested that VEGF-165/BMP-2 gene transfection strengthened osteogenic effects of BMSCs, elevated number and quality of new bones and accelerated the repair of osteonecrosis of the femoral head. PMID:26629044

  2. Effect of Anatomically Realistic Full-Head Model on Activation of Cortical Neurons in Subdural Cortical Stimulation—A Computational Study

    PubMed Central

    Seo, Hyeon; Kim, Donghyeon; Jun, Sung Chan

    2016-01-01

    Electrical brain stimulation (EBS) is an emerging therapy for the treatment of neurological disorders, and computational modeling studies of EBS have been used to determine the optimal parameters for highly cost-effective electrotherapy. Recent notable growth in computing capability has enabled researchers to consider an anatomically realistic head model that represents the full head and complex geometry of the brain rather than the previous simplified partial head model (extruded slab) that represents only the precentral gyrus. In this work, subdural cortical stimulation (SuCS) was found to offer a better understanding of the differential activation of cortical neurons in the anatomically realistic full-head model than in the simplified partial-head models. We observed that layer 3 pyramidal neurons had comparable stimulation thresholds in both head models, while layer 5 pyramidal neurons showed a notable discrepancy between the models; in particular, layer 5 pyramidal neurons demonstrated asymmetry in the thresholds and action potential initiation sites in the anatomically realistic full-head model. Overall, the anatomically realistic full-head model may offer a better understanding of layer 5 pyramidal neuronal responses. Accordingly, the effects of using the realistic full-head model in SuCS are compelling in computational modeling studies, even though this modeling requires substantially more effort. PMID:27273817

  3. Effect of Anatomically Realistic Full-Head Model on Activation of Cortical Neurons in Subdural Cortical Stimulation-A Computational Study.

    PubMed

    Seo, Hyeon; Kim, Donghyeon; Jun, Sung Chan

    2016-01-01

    Electrical brain stimulation (EBS) is an emerging therapy for the treatment of neurological disorders, and computational modeling studies of EBS have been used to determine the optimal parameters for highly cost-effective electrotherapy. Recent notable growth in computing capability has enabled researchers to consider an anatomically realistic head model that represents the full head and complex geometry of the brain rather than the previous simplified partial head model (extruded slab) that represents only the precentral gyrus. In this work, subdural cortical stimulation (SuCS) was found to offer a better understanding of the differential activation of cortical neurons in the anatomically realistic full-head model than in the simplified partial-head models. We observed that layer 3 pyramidal neurons had comparable stimulation thresholds in both head models, while layer 5 pyramidal neurons showed a notable discrepancy between the models; in particular, layer 5 pyramidal neurons demonstrated asymmetry in the thresholds and action potential initiation sites in the anatomically realistic full-head model. Overall, the anatomically realistic full-head model may offer a better understanding of layer 5 pyramidal neuronal responses. Accordingly, the effects of using the realistic full-head model in SuCS are compelling in computational modeling studies, even though this modeling requires substantially more effort. PMID:27273817

  4. Effect of Anatomically Realistic Full-Head Model on Activation of Cortical Neurons in Subdural Cortical Stimulation—A Computational Study

    NASA Astrophysics Data System (ADS)

    Seo, Hyeon; Kim, Donghyeon; Jun, Sung Chan

    2016-06-01

    Electrical brain stimulation (EBS) is an emerging therapy for the treatment of neurological disorders, and computational modeling studies of EBS have been used to determine the optimal parameters for highly cost-effective electrotherapy. Recent notable growth in computing capability has enabled researchers to consider an anatomically realistic head model that represents the full head and complex geometry of the brain rather than the previous simplified partial head model (extruded slab) that represents only the precentral gyrus. In this work, subdural cortical stimulation (SuCS) was found to offer a better understanding of the differential activation of cortical neurons in the anatomically realistic full-head model than in the simplified partial-head models. We observed that layer 3 pyramidal neurons had comparable stimulation thresholds in both head models, while layer 5 pyramidal neurons showed a notable discrepancy between the models; in particular, layer 5 pyramidal neurons demonstrated asymmetry in the thresholds and action potential initiation sites in the anatomically realistic full-head model. Overall, the anatomically realistic full-head model may offer a better understanding of layer 5 pyramidal neuronal responses. Accordingly, the effects of using the realistic full-head model in SuCS are compelling in computational modeling studies, even though this modeling requires substantially more effort.

  5. Conservative management of medication-related osteonecrosis of the maxilla with an obturator prosthesis.

    PubMed

    Troeltzsch, Matthias; Probst, Florian; Troeltzsch, Markus; Ehrenfeld, Michael; Otto, Sven

    2015-03-01

    Advanced maxillary medication-related osteonecrosis of the jaw can cause extensive hard and soft tissue destruction that results in long-term oroantral fistulae. The surgical treatment of medication-related osteonecrosis of the jaw may relieve acute symptoms and eliminate the signs of inflammation, but the primary and sustained plastic closure of these defects can challenge both the clinician and the patients. Although the use of obturator prostheses for maxillary defects after ablative oncologic surgery is well documented, studies about this treatment for similar medication-related osteonecrosis of the jaw-related defects are missing. This presentation of clinical situations describes the use of obturators as a conservative alternative to repetitive surgery for the rehabilitation of selected maxillary defects with oroantral communications. PMID:25444286

  6. Testosterone, anastrozole, factor V Leiden heterozygosity and osteonecrosis of the jaws.

    PubMed

    Pandit, Ramesh S; Glueck, Charles J

    2014-04-01

    Our specific aim is to describe the development of thrombotic osteonecrosis of the jaws after testosterone-anastrozole therapy in a 55-year-old white man subsequently found to have previously undiagnosed factor V Leiden heterozygosity. Before the diagnosis of V Leiden heterozygosity, he was given testosterone gel, 50 mg/day, and on testosterone, serum testosterone (963 ng/dl) and estradiol were high (50 pg/ml). Anastrozole was started, and testosterone was continued. Six months later, osteonecrosis of the jaws was diagnosed. Exogenous testosterone is aromatized to estradiol and estradiol-induced thrombophilia, when superimposed on underlying familial thrombophilia, as in this case, may lead to thrombosis and osteonecrosis. We recommend that before giving testosterone, at a minimum, screening for the factor V Leiden and G20210A mutations, and factor VIII and XI activity be carried out, to avoid unanticipated thrombosis. PMID:24674881

  7. [Bisphosphonate and denosumab-related osteonecrosis of the jaw: Epidemiology, diagnosis and management].

    PubMed

    Dupic, Guillaume; Collangettes, Denise; Dillies, Anne-Françoise; Calvet, Laure; Tournilhac, Olivier; Bay, Jacques-Olivier; Mahammedi, Hakim

    2015-12-01

    Bisphosphonate-related osteonecrosis of the jaw have been widely described. Denosumab has recently been associated to ONJ. Guidance to clinicians is based on criteria established by the American Association of Oral and Maxillofacial Surgeons (AAOMS). Treatment should be multidisciplinary. Two options are available and have to be discussed on the basis of associated therapeutic, patient's general state of health and possibility of therapeutic window during cancer treatment: conservative (medication and conservative surgery like superficial debridement) and extensive surgery. Therefore, we report an update about management strategies of osteonecrosis of the jaw and two cases of patients with a stage 2 osteonecrosis of the jaw only treated with mouth rinses, antibiotics and debridement and complete healing. PMID:26607453

  8. A Naturally Occurring Feline Model of Head and Neck Squamous Cell Carcinoma

    PubMed Central

    Wypij, Jackie M.

    2013-01-01

    Despite advances in understanding cancer at the molecular level, timely and effective translation to clinical application of novel therapeutics in human cancer patients is lacking. Cancer drug failure is often a result of toxicity or inefficacy not predicted by preclinical models, emphasizing the need for alternative animal tumor models with improved biologic relevancy. Companion animals (dogs and cats) provide an opportunity to capitalize on an underutilized and biologically relevant translational research model which allows spontaneous disease modeling of human cancer. Head and neck squamous cell carcinoma (HNSCC) is a common cancer with a poor prognosis and limited clinical advancements in recent years. One potential novel spontaneous animal tumor model is feline oral squamous cell carcinoma (FOSCC). FOSCC and HNSCC share similar etiopathogenesis (tobacco and papillomavirus exposure) and molecular markers (EGFR, VEGF, and p53). Both human and feline SCCs share similar tumor biology, clinical outcome, treatment, and prognosis. Future clinical trials utilizing FOSCC as a tumor model may facilitate translation of preclinical cancer research for human cancer patients. PMID:23970998

  9. Using an evolutionary algorithm to determine the parameters of a biologically inspired model of head direction cells.

    PubMed

    Kyriacou, Theocharis

    2012-04-01

    A biologically inspired model of head direction cells is presented and tested on a small mobile robot. Head direction cells (discovered in the brain of rats in 1984) encode the head orientation of their host irrespective of the host's location in the environment. The head direction system thus acts as a biological compass (though not a magnetic one) for its host. Head direction cells are influenced in different ways by idiothetic (host-centred) and allothetic (not host-centred) cues. The model presented here uses the visual, vestibular and kinesthetic inputs that are simulated by robot sensors. Real robot-sensor data has been used in order to train the model's artificial neural network connections. The main contribution of this paper lies in the use of an evolutionary algorithm in order to determine the values of parameters that determine the behaviour of the model. More importantly, the objective function of the evolutionary strategy used takes into consideration quantitative biological observations reported in the literature. PMID:21785973

  10. Establishment of a prediction model for the miRNA-based heading date characteristics of rice in the booting stage.

    PubMed

    Chen, Y C; Lin, W S; Chen, R K; Chao, Y Y; Chin, S W; Chen, F C; Lee, C Y

    2015-01-01

    Rice (Oryza sativa L.) is one of the most important food crops in the world. In Taiwan, due to the warm climate, there are two harvests annually. However, the yield and quality of rice can vary between each crop season in any given year. Previous reports have shown that microRNAs (miRNAs) play a crucial role in many developmental and physiological processes in plants. In this study, the heading date characteristics of 167 rice cultivars from the second crop season were recorded, and 27 rice cultivars were selected for preliminary microarray analysis. A total of 14 miRNAs from different heading date characteristics in 21 cultivars were selected based on significant differences in their expression profiles. Using a correlation analysis between the heading date and selected miRNA expression obtained from real-time polymerase chain reaction (PCR) assays, we developed a heading date prediction model. The model includes nine miRNA genes with corresponding R2 values of 0.8. To confirm the model, a real-time PCR analysis was performed on an additional 27 rice cultivars and we found the model predicted the heading date with accuracy. Therefore, the developed prediction may be useful in further studies aimed at confirming the reliability of the use of miRNA in molecular breeding and to increase the selection efficiency of rice cultivars and breeding. PMID:25966211

  11. Quantitative Relationship between Axonal Injury and Mechanical Response in a Rodent Head Impact Acceleration Model

    PubMed Central

    Li, Yan; Kallakuri, Srinivasu; Zhou, Runzhou; Cavanaugh, John M.

    2011-01-01

    Abstract A modified Marmarou impact acceleration model was developed to study the mechanical responses induced by this model and their correlation to traumatic axonal injury (TAI). Traumatic brain injury (TBI) was induced in 31 anesthetized male Sprague-Dawley rats (392±13 g) by a custom-made 450-g impactor from heights of 1.25 m or 2.25 m. An accelerometer and angular rate sensor measured the linear and angular responses of the head, while the impact event was captured by a high-speed video camera. TAI distribution along the rostro-caudal direction, as well as across the left and right hemispheres, was determined using β-amyloid precursor protein (β-APP) immunocytochemistry, and detailed TAI injury maps were constructed for the entire corpus callosum. Peak linear acceleration 1.25 m and 2.25 m impacts were 666±165 g and 907±501 g, respectively. Peak angular velocities were 95±24 rad/sec and 124±48 rad/sec, respectively. Compared to the 2.25-m group, the observed TAI counts in the 1.25-m impact group were significantly lower. Average linear acceleration, peak angular velocity, average angular acceleration, and surface righting time were also significantly different between the two groups. A positive correlation was observed between normalized total TAI counts and average linear acceleration (R2=0.612, p<0.05), and time to surface right (R2=0.545, p<0.05). Our study suggested that a 2.25-m drop in the Marmarou model may not always result in a severe injury, and TAI level is related to the linear and angular acceleration response of the rat head during impact, not necessarily the drop height. PMID:21895482

  12. Rheumatoid Arthritis Exacerbates the Severity of Osteonecrosis of the Jaws (ONJ) in Mice. A Randomized, Prospective, Controlled Animal Study.

    PubMed

    de Molon, Rafael Scaf; Hsu, Chingyun; Bezouglaia, Olga; Dry, Sarah M; Pirih, Flavia Q; Soundia, Akrivoula; Cunha, Fernando Queiroz; Cirelli, Joni Augusto; Aghaloo, Tara L; Tetradis, Sotirios

    2016-08-01

    Rheumatoid arthritis (RA), an autoimmune inflammatory disorder, results in persistent synovitis with severe bone and cartilage destruction. Bisphosphonates (BPs) are often utilized in RA patients to reduce bone destruction and manage osteoporosis. However, BPs, especially at high doses, are associated with osteonecrosis of the jaw (ONJ). Here, utilizing previously published ONJ animal models, we are exploring interactions between RA and ONJ incidence and severity. DBA1/J mice were divided into four groups: control, zoledronic acid (ZA), collagen-induced arthritis (CIA), and CIA-ZA. Animals were pretreated with vehicle or ZA. Bovine collagen II emulsified in Freund's adjuvant was injected to induce arthritis (CIA) and the mandibular molar crowns were drilled to induce periapical disease. Vehicle or ZA treatment continued for 8 weeks. ONJ indices were measured by micro-CT (µCT) and histological examination of maxillae and mandibles. Arthritis development was assessed by visual scoring of paw swelling, and by µCT and histology of interphalangeal and knee joints. Maxillae and mandibles of control and CIA mice showed bone loss, periodontal ligament (PDL) space widening, lamina dura loss, and cortex thinning. ZA prevented these changes in both ZA and CIA-ZA groups. Epithelial to alveolar crest distance was increased in the control and CIA mice. This distance was preserved in ZA and CIA-ZA animals. Empty osteocytic lacunae and areas of osteonecrosis were present in ZA and CIA-ZA but more extensively in CIA-ZA animals, indicating more severe ONJ. CIA and CIA-ZA groups developed severe arthritis in the paws and knees. Interphalangeal and knee joints of CIA mice showed advanced bone destruction with cortical erosions and trabecular bone loss, and ZA treatment reduced these effects. Importantly, no osteonecrosis was noted adjacent to areas of articular inflammation in CIA-ZA mice. Our data suggest that ONJ burden was more pronounced in ZA treated CIA mice and that RA could

  13. Genetics of glucocorticoid-associated osteonecrosis in children with acute lymphoblastic leukemia.

    PubMed

    Karol, Seth E; Yang, Wenjian; Van Driest, Sara L; Chang, Tamara Y; Kaste, Sue; Bowton, Erica; Basford, Melissa; Bastarache, Lisa; Roden, Dan M; Denny, Joshua C; Larsen, Eric; Winick, Naomi; Carroll, William L; Cheng, Cheng; Pei, Deqing; Fernandez, Christian A; Liu, Chengcheng; Smith, Colton; Loh, Mignon L; Raetz, Elizabeth A; Hunger, Stephen P; Scheet, Paul; Jeha, Sima; Pui, Ching-Hon; Evans, William E; Devidas, Meenakshi; Mattano, Leonard A; Relling, Mary V

    2015-10-01

    Glucocorticoids are important therapy for acute lymphoblastic leukemia (ALL) and their major adverse effect is osteonecrosis. Our goal was to identify genetic and nongenetic risk factors for osteonecrosis. We performed a genome-wide association study of single nucleotide polymorphisms (SNPs) in a discovery cohort comprising 2285 children with ALL, treated on the Children's Oncology Group AALL0232 protocol (NCT00075725), adjusting for covariates. The minor allele at SNP rs10989692 (near the glutamate receptor GRIN3A locus) was associated with osteonecrosis (hazard ratio = 2.03; P = 3.59 × 10(-7)). The association was supported by 2 replication cohorts, including 361 children with ALL on St. Jude's Total XV protocol (NCT00137111) and 309 non-ALL patients from Vanderbilt University's BioVU repository treated with glucocorticoids (odds ratio [OR] = 1.87 and 2.26; P = .063 and .0074, respectively). In a meta-analysis, rs10989692 was also highest ranked (P = 2.68 × 10(-8)), and the glutamate pathway was the top ranked pathway (P = 9.8 × 10(-4)). Osteonecrosis-associated glutamate receptor variants were also associated with other vascular phenotypes including cerebral ischemia (OR = 1.64; P = 2.5 × 10(-3)), and arterial embolism and thrombosis (OR = 1.88; P = 4.2 × 10(-3)). In conclusion, osteonecrosis was associated with inherited variations near glutamate receptor genes. Further understanding this association may allow interventions to decrease osteonecrosis. These trials are registered at www.clinicaltrials.gov as #NCT00075725 and #NCT00137111. PMID:26265699

  14. Power deposition in the head and neck of an anatomically based human body model for plane wave exposures

    NASA Astrophysics Data System (ADS)

    Tinniswood, A. D.; Furse, C. M.; Gandhi, O. P.

    1998-08-01

    At certain frequencies, when the human head becomes a resonant structure, the power absorbed by the head and neck, when the body is exposed to a vertically polarized plane wave propagating from front to back, becomes significantly larger than would ordinarily be expected from its shadow cross section. This has possible implications in the study of the biological effects of electromagnetic fields. Additionally the frequencies at which these resonances occur are not readily predicted by simple approximations of the head in isolation. In order to determine these resonant conditions an anatomically based model of the whole human body has been used, with the finite-difference time-domain (FDTD) algorithm to accurately determine field propagation, specific absorption rate (SAR) distributions and power absorption in both the whole body and the head region (head and neck). This paper shows that resonant frequencies can be determined using two methods. The first is by use of the accurate anatomically based model (with heterogeneous tissue properties) and secondly using a model built from parallelepiped sections (for the torso and legs), an ellipsoid for the head and a cylinder for the neck. This approximation to the human body is built from homogeneous tissue the equivalent of two-thirds the conductivity and dielectric constant of that of muscle. An IBM SP-2 supercomputer together with a parallel FDTD code has been used to accommodate the large problem size. We find resonant frequencies for the head and neck at 207 MHz and 193 MHz for the isolated and grounded conditions, with absorption cross sections that are respectively 3.27 and 2.62 times the shadow cross section.

  15. A general photon source model for clinical linac heads in photon mode

    NASA Astrophysics Data System (ADS)

    González, W.; García-Ferreira, I.-B.; Anguiano, M.; Lallena, A. M.

    2015-12-01

    In this work a general photon source model has been developed to describe clinical linac heads when operating in photon mode. Six different linacs (three operating at 6 MV, one at 15 MV and two at 18 MV) have been studied. The construction of the model as well as its validation have been carried out on the base of the virtual linac approach in which the complete linac geometries have been simulated with the Monte Carlo code PENELOPE. The model includes a primary and a secondary sources whose geometrical characteristics are determined from a set of simulated fluence distributions in air. The photon energy distributions are obtained from the Monte Carlo energy distributions of the photons moving along the beam axis, using a softening function that depends on the nominal energy of the beam and a Compton-like correction. To verify the model, output factors, percentage depth doses and transverse profiles in water obtained from a calculation performed with the complete geometry are compared to those found with the source model. A reasonable agreement is obtained in all cases analyzed except for the 18 MV Mevatron KDS linac for the 20 cm× 20 cm field.

  16. An eye model for uncalibrated eye gaze estimation under variable head pose

    NASA Astrophysics Data System (ADS)

    Hnatow, Justin; Savakis, Andreas

    2007-04-01

    Gaze estimation is an important component of computer vision systems that monitor human activity for surveillance, human-computer interaction, and various other applications including iris recognition. Gaze estimation methods are particularly valuable when they are non-intrusive, do not require calibration, and generalize well across users. This paper presents a novel eye model that is employed for efficiently performing uncalibrated eye gaze estimation. The proposed eye model was constructed from a geometric simplification of the eye and anthropometric data about eye feature sizes in order to circumvent the requirement of calibration procedures for each individual user. The positions of the two eye corners and the midpupil, the distance between the two eye corners, and the radius of the eye sphere are required for gaze angle calculation. The locations of the eye corners and midpupil are estimated via processing following eye detection, and the remaining parameters are obtained from anthropometric data. This eye model is easily extended to estimating eye gaze under variable head pose. The eye model was tested on still images of subjects at frontal pose (0 °) and side pose (34 °). An upper bound of the model's performance was obtained by manually selecting the eye feature locations. The resulting average absolute error was 2.98 ° for frontal pose and 2.87 ° for side pose. The error was consistent across subjects, which indicates that good generalization was obtained. This level of performance compares well with other gaze estimation systems that utilize a calibration procedure to measure eye features.

  17. Trunnion-Head Stresses in THA: Are Big Heads Trouble?

    PubMed

    Lavernia, Carlos J; Iacobelli, David A; Villa, Jesus M; Jones, Kinzy; Gonzalez, Jose L; Jones, William Kinzy

    2015-06-01

    The effects of large heads on stresses at the THA trunnion-head junction and their impact on tribocorrosion/metal ion release remain controversial. A 12/14 3D-model of a stem with different head sizes was investigated. Material properties of titanium were assigned to the trunnion and cobalt-chrome/alumina to the heads. A load simulating walking single-leg stand phase was applied to the head. A total contact head-trunnion interface was assumed. The area underneath the junction underwent significant elevations in stresses as head size increased from 28- to 40-mm. Maximum principal stress doubled between 28 and 40-mm heads, regardless of head material. Stress levels had a direct correlation to head diameter. Stress increases observed using increasingly larger heads will probably contribute to head-trunnion tribocorrosion and ion release. PMID:25724112

  18. Computer modeling of infrared head-on emission from missile noses

    SciTech Connect

    Tofani, A. )

    1990-02-01

    A computer model that takes into account the effect of aerodynamic and solar heating, sky irradiation, and radiative cooling on infrared emission from missile noses is presented. The heat transfer equation was solved with numerical techniques both in the steady-state (constant sped and altitude flight of cruise missiles) and in the nonstationary regime (quickly variable speed and altitude of short to medium range ballistic missiles) to give the temperature distribution on the skin surface. The corresponding head-on absolute infrared emission in the 3 to 5 {mu}m spectral bands was computed as a function of time of flight and missile altitude. Results show a strong dependence of temperature on the skin material, on the character of the aerodynamic flow (laminar or turbulent boundary layer), and on the physical characteristics of the atmosphere. By varying these parameters into reasonable ranges, infrared emissions spanning over more than an order of magnitude were obtained.

  19. Bisphosphonate-related osteonecrosis of the jaw complicated by Ludwig's angina.

    PubMed

    Yang, Rong-Hsin; Shen, Shu-Huei; Li, Wing-Yin; Chu, Yum-Kung

    2015-01-01

    Ludwig's angina is a life-threatening cellulitis that involves the submandibular and sublingual spaces. It often occurs after an infection of the roots of the teeth. However, modern dental care and use of antibiotics for oral infections have made Ludwig's angina rare. We present here a cancer patient exhibiting the sequential features of bisphosphonate related osteonecrosis of the jaw on bone scan complicating with Ludwig's angina. This report highlights the need for medical practitioners to be alert to these rare combinations in the compromised patient after bisphosphonate therapy. To the best of our knowledge, no case of Ludwig's angina secondary to osteonecrosis of the jaw has been reported. PMID:25074798

  20. Removal of trabecular metal osteonecrosis intervention implant and conversion to primary total hip arthroplasty.

    PubMed

    Owens, Joshua B; Ely, Erin E; Guilliani, Nathania M Figueroa; Suarez, Juan C; Patel, Preetesh D

    2012-06-01

    Core decompression and placement of the Trabecular Metal Osteonecrosis Intervention Implant have shown to be initially successful in treating early osteonecrosis. When treatment fails, however, patients often undergo primary total hip arthroplasty (THA) requiring removal of a previously inserted trabecular metal implant. We describe a technical tip for removal of a well-ingrown trabecular metal screw. A metal-cutting trephine placed over the screw allows for removal in an efficient manner while minimizing additional dissection and bone loss during conversion to THA. PMID:22425306

  1. Denosumab-related osteonecrosis of the jaws: successful management with a conservative surgical approach.

    PubMed

    de Souza Póvoa, Raphaela Capella; Marlierè, Daniel Amaral Alves; da Silveira, Henrique Martins; Pires, Fábio Ramoa

    2016-07-01

    Denosumab-related osteonecrosis of the jaws (DRONJ) is a recently described entity that shares many common clinical and radiological features with bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of the present study is to report a case of DRONJ affecting the anterior mandible of a 58-year-old male treated with denosumab to prevent skeletal-related events associated with prostate cancer. Conservative surgery in conjunction with antibiotic therapy and discontinuation of denosumab use were effective in managing the condition and the patient remains free of clinical and radiological changes after a 38 month follow-up. PMID:26859582

  2. Behavior and modeling of two-dimensional precedence effect in head-unrestrained cats

    PubMed Central

    Ruhland, Janet L.; Yin, Tom C. T.

    2015-01-01

    The precedence effect (PE) is an auditory illusion that occurs when listeners localize nearly coincident and similar sounds from different spatial locations, such as a direct sound and its echo. It has mostly been studied in humans and animals with immobile heads in the horizontal plane; speaker pairs were often symmetrically located in the frontal hemifield. The present study examined the PE in head-unrestrained cats for a variety of paired-sound conditions along the horizontal, vertical, and diagonal axes. Cats were trained with operant conditioning to direct their gaze to the perceived sound location. Stereotypical PE-like behaviors were observed for speaker pairs placed in azimuth or diagonally in the frontal hemifield as the interstimulus delay was varied. For speaker pairs in the median sagittal plane, no clear PE-like behavior occurred. Interestingly, when speakers were placed diagonally in front of the cat, certain PE-like behavior emerged along the vertical dimension. However, PE-like behavior was not observed when both speakers were located in the left hemifield. A Hodgkin-Huxley model was used to simulate responses of neurons in the medial superior olive (MSO) to sound pairs in azimuth. The novel simulation incorporated a low-threshold potassium current and frequency mismatches to generate internal delays. The model exhibited distinct PE-like behavior, such as summing localization and localization dominance. The simulation indicated that certain encoding of the PE could have occurred before information reaches the inferior colliculus, and MSO neurons with binaural inputs having mismatched characteristic frequencies may play an important role. PMID:26133795

  3. Volume-averaged SAR in adult and child head models when using mobile phones: a computational study with detailed CAD-based models of commercial mobile phones.

    PubMed

    Keshvari, Jafar; Heikkilä, Teemu

    2011-12-01

    Previous studies comparing SAR difference in the head of children and adults used highly simplified generic models or half-wave dipole antennas. The objective of this study was to investigate the SAR difference in the head of children and adults using realistic EMF sources based on CAD models of commercial mobile phones. Four MRI-based head phantoms were used in the study. CAD models of Nokia 8310 and 6630 mobile phones were used as exposure sources. Commercially available FDTD software was used for the SAR calculations. SAR values were simulated at frequencies 900 MHz and 1747 MHz for Nokia 8310, and 900 MHz, 1747 MHz and 1950 MHz for Nokia 6630. The main finding of this study was that the SAR distribution/variation in the head models highly depends on the structure of the antenna and phone model, which suggests that the type of the exposure source is the main parameter in EMF exposure studies to be focused on. Although the previous findings regarding significant role of the anatomy of the head, phone position, frequency, local tissue inhomogeneity and tissue composition specifically in the exposed area on SAR difference were confirmed, the SAR values and SAR distributions caused by generic source models cannot be extrapolated to the real device exposures. The general conclusion is that from a volume averaged SAR point of view, no systematic differences between child and adult heads were found. PMID:22005524

  4. A current review of core decompression in the treatment of osteonecrosis of the femoral head.

    PubMed

    Pierce, Todd P; Jauregui, Julio J; Elmallah, Randa K; Lavernia, Carlos J; Mont, Michael A; Nace, James

    2015-09-01

    The review describes the following: (1) how traditional core decompression is performed, (2) adjunctive treatments, (3) multiple percutaneous drilling technique, and (4) the overall outcomes of these procedures. Core decompression has optimal outcomes when used in the earliest, precollapse disease stages. More recent studies have reported excellent outcomes with percutaneous drilling. Furthermore, adjunct treatment methods combining core decompression with growth factors, bone morphogenic proteins, stem cells, and bone grafting have demonstrated positive results; however, larger randomized trial is needed to evaluate their overall efficacy. PMID:26045085

  5. Head circumference

    MedlinePlus

    ... a child's head circumference Normal ranges for a child's sex and age (weeks, months), based on values that experts have obtained for normal growth rates of infants' and children's heads Measurement of the head circumference is an ...

  6. Head Lice

    MedlinePlus

    Head lice are parasitic wingless insects. They live on people's heads and feed on their blood. An adult louse ... Children ages 3-11 and their families get head lice most often. Personal hygiene has nothing to ...

  7. Head Injuries

    MedlinePlus

    ... of head injuries include bicycle or motorcycle wrecks, sports injuries, falls from windows (especially among children who live ... to watch for? When can I start playing sports again after a head injury? How can brain damage from a head injury ...

  8. Head Lice

    MedlinePlus

    Head lice are parasitic wingless insects. They live on people's heads and feed on their blood. An adult ... Children ages 3-11 and their families get head lice most often. Personal hygiene has nothing to do ...

  9. Preclinical modeling of EGFR inhibitor resistance in head and neck cancer

    PubMed Central

    Quesnelle, Kelly M.; Wheeler, Sarah E.; Ratay, Mary K.; Grandis, Jennifer R.

    2012-01-01

    The epidermal growth factor receptor (EGFR) is widely expressed in head and neck squamous cell carcinomas (HNSCC) and can activate many growth and survival pathways within tumor cells. Despite ubiquitous EGFR expression, therapies targeting the receptor are only modestly effective in the treatment of HNSCC. A consistent mechanism of resistance to EGFR targeting agents has not yet been identified in HNSCC likely due, in part, to the paucity of preclinical models. We assessed the in vitro and in vivo responses of a panel of 10 genotypically validated HNSCC cell lines to the EGFR inhibitors erlotinib and cetuximab to determine their validity as models of resistance to these agents. We defined a narrow range of response to erlotinib in HNSCC cells in vitro and found a positive correlation between EGFR protein expression and erlotinib response. We observed cross-sensitivity in one HNSCC cell line, 686LN, between erlotinib and cetuximab in vivo. We attempted to generate models of cetuximab resistance in HNSCC cell line-derived xenografts and heterotopic tumorgrafts generated directly from primary patient tumors. While all 10 HNSCC cell line xenografts tested were sensitive to cetuximab in vivo, heterotopic patient tumorgrafts varied in response to cetuximab indicating that these models may be more representative of clinical responses. These studies demonstrate the limitations of using HNSCC cell lines to reflect the heterogeneous clinical responses to erlotinib and cetuximab, and suggest that different approaches including heterotopic tumorgrafts may prove more valuable to elucidate mechanisms of clinical resistance to EGFR inhibitors in HNSCC. PMID:22785204

  10. A model of the release of myosin heads from actin in rapidly contracting muscle fibers.

    PubMed Central

    Cooke, R; White, H; Pate, E

    1994-01-01

    We describe a model that relates the maximum shortening velocity of a muscle fiber, Vm, to the kinetics of the dissociation of a myosin head from actin. At Vm, the positive work exerted by cross-bridges attached in the powerstroke must be balanced by cross-bridges that have been carried by movement of the filaments into a region where they exert a negative force. This balance allows one to relate Vm and the rate of cross-bridge detachment. Studies of actomyosin kinetics suggest that at high substrate, detachment should be limited by a slow protein isomerization (approximately 50 s-1) that precedes ADP release. This rate is too slow to be easily accommodated in existing models. However, a slow rate for cross-bridge dissociation, similar to that of the isomerization, is predicted if previous models are modified to include rapid detachment of cross-bridges that have been carried so far into the negative force region that their free energy exceeds that of the detached state. The model also explains another aspect of muscle contraction: at high shortening velocities, the observed rate of ATP hydrolysis is low, because a cross-bridge can interact with multiple actin binding sites before releasing the hydrolysis products and binding another ATP. PMID:8011910

  11. Animal models of sports-related head injury: bridging the gap between pre-clinical research and clinical reality

    PubMed Central

    Angoa-Pérez, Mariana; Kane, Michael J.; Briggs, Denise I.; Herrera-Mundo, Nieves; Viano, David C.; Kuhn, Donald M.

    2016-01-01

    Sports-related head impact and injury has become a very highly contentious public health and medico-legal issue. Near-daily news accounts describe the travails of concussed athletes as they struggle with depression, sleep disorders, mood swings, and cognitive problems. Some of these individuals have developed chronic traumatic encephalopathy, a progressive and debilitating neurodegenerative disorder. Animal models have always been an integral part of the study of traumatic brain injury in humans but, historically, they have concentrated on acute, severe brain injuries. This review will describe a small number of new and emerging animal models of sports-related head injury that have the potential to increase our understanding of how multiple mild head impacts, starting in adolescence, can have serious psychiatric, cognitive and histopathological outcomes much later in life. PMID:24673291

  12. MCNP Analytical Models of a Calibration Head Phantom for Bone-Seeker Nuclides In Vivo Measurements

    NASA Astrophysics Data System (ADS)

    Gualdrini, G.; Ferrari, P.; Battisti, P.; De Felice, P.; Pierotti, L.

    Dosimetric studies related to internal contamination from actinides, characterised by a gamma or X-ray emission, can be done using Whole Body Counters (WBC), equipped with Germanium detectors. Their calibration requires suitable plastic phantoms, activated with a known quantity of the investigated radionuclide, to reproduce the contamination of the individual, or of the particular target organ. In order to detect low energy photon emitters, some long-lived daughter nuclei, characterised by higher energy emission, are usually selected as markers. In the case of Plutonium the internationally accepted practice is to employ 241 Am (nearly 60 keV gamma emission) taken as a marker of actinide previous contamination [1]. These actinides deposit, during their long retention period (over 20 years), in the skeleton and in the liver. Taking into account that the low energy of the emitted photons makes the measurement strongly sensitive to the thickness of the soft tissue surrounding the bones (and therefore very much subject-dependent), it is advised to perform the measurement on the head, to minimise the individual variation of the soft tissue thickness. The measured head activity can be thereafter extrapolated to the whole skeleton. The previous considerations justify the importance of developing a suitable head calibration phantom to be activated with known activity radioactive sources in order to well approximate the assumed homogeneous contamination encountered in the real practice. The main difficulty is represented by the complexity of the radioactive source itself which is the skull of the plastic phantom. Since many years Monte Carlo techniques have been used to simulate internal dosimetry measurements with satisfactory results [2-4]. This paper describes the method followed to work out this problem relying on the capabilities of the Monte Carlo code MCNP [5]. The code was employed both to determine the best distribution a set of 24 point sources, to simulate a

  13. Induced EM field in a layered eccentric spheres model of the head: Plane-wave and localized source exposure

    SciTech Connect

    Skaropoulos, N.C.; Ioannidou, M.P.; Chrissoulidis, D.P.

    1996-10-01

    Understanding the interaction of EM radiation with humans is essential in a number of contemporary applications. Special attention is paid to the absorption of EM energy by the human head, which exhibits a resonant behavior in the frequency band 0.1--3 GHz. The use of handheld transceivers for wireless communications, which operate in close proximity to the head, has raised safety-related questions and questions concerning the effect of the head on the performance of the mobile phone antenna. The induced electromagnetic (EM) field in a layered eccentric spheres structure is determined through a concise analytical formulation based on indirect mode-matching (IMM). The exact analytical solution is applied to a six-layer model of the head. This model allows for eccentricity between the inner and outer sets of concentric spherical layers which simulate brain and skull, respectively. Excitation is provided by a nearby localized source or by an incident plane wave. The numerical application provides information about the total absorbed power, the absorption in each layer, and the spatial distribution of the specific absorption rate (SAR) at frequencies used by cellular phones. The effects of excitation frequency, eccentricity, exposure configuration, and antenna-head separation are investigated.

  14. Injury predictors for traumatic axonal injury in a rodent head impact acceleration model.

    PubMed

    Li, Yan; Zhang, Liying; Kallakuri, Srinivasu; Zhou, Runzhou; Cavanaugh, John M

    2011-11-01

    A modified Marmarou impact acceleration injury model was developed to study the kinematics of the rat head to quantify traumatic axonal injury (TAI) in the corpus callosum (CC) and brainstem pyramidal tract (Py), to determine injury predictors and to establish injury thresholds for severe TAI. Thirty-one anesthetized male Sprague-Dawley rats (392±13 grams) were impacted using a modified impact acceleration injury device from 2.25 m and 1.25 m heights. Beta-amyloid precursor protein (β-APP) immunocytochemistry was used to assess and quantify axonal changes in CC and Py. Over 600 injury maps in CC and Py were constructed in the 31 impacted rats. TAI distribution along the rostro-caudal direction in CC and Py was determined. Linear and angular responses of the rat head were monitored and measured in vivo with an attached accelerometer and angular rate sensor, and were correlated to TAI data. Logistic regression analysis suggested that the occurrence of severe TAI in CC was best predicted by average linear acceleration, followed by power and time to surface righting. The combination of average linear acceleration and time to surface righting showed an improved predictive result. In Py, severe TAI was best predicted by time to surface righting, followed by peak and average angular velocity. When both CC and Py were combined, power was the best predictor, and the combined average linear acceleration and average angular velocity was also found to have good injury predictive ability. Receiver operator characteristic curves were used to assess the predictive power of individual and paired injury predictors. TAI tolerance curves were also proposed in this study. PMID:22869303

  15. Thermal modeling of head disk interface system in heat assisted magnetic recording

    SciTech Connect

    Vemuri, Sesha Hari; Seung Chung, Pil; Jhon, Myung S.; Min Kim, Hyung

    2014-05-07

    A thorough understanding of the temperature profiles introduced by the heat assisted magnetic recording is required to maintain the hotspot at the desired location on the disk with minimal heat damage to other components. Here, we implement a transient mesoscale modeling methodology termed lattice Boltzmann method (LBM) for phonons (which are primary carriers of energy) in the thermal modeling of the head disk interface (HDI) components, namely, carbon overcoat (COC). The LBM can provide more accurate results compared to conventional Fourier methodology by capturing the nanoscale phenomena due to ballistic heat transfer. We examine the in-plane and out-of-plane heat transfer in the COC via analyzing the temperature profiles with a continuously focused and pulsed laser beam on a moving disk. Larger in-plane hotspot widening is observed in continuously focused laser beam compared to a pulsed laser. A pulsed laser surface develops steeper temperature gradients compared to continuous hotspot. Furthermore, out-of-plane heat transfer from the COC to the media is enhanced with a continuous laser beam then a pulsed laser, while the temperature takes around 140 fs to reach the bottom surface of the COC. Our study can lead to a realistic thermal model describing novel HDI material design criteria for the next generation of hard disk drives with ultra high recording densities.

  16. SCDAP/RELAP5 modeling of heat transfer and flow losses in lower head porous debris. Revision 1

    SciTech Connect

    Siefken, L.J.; Coryell, E.W.; Paik, S.; Kuo, H.

    1999-05-01

    Designs are described for implementing models for calculating the heat transfer and flow losses in porous debris in the lower head of a reactor vessel. The COUPLE model in SCDAP/RELAP5 represents both the porous and nonporous debris that results from core material slumping into the lower head. Currently, the COUPLE model has the capability to model convective and radiative heat transfer from the surfaces of nonporous debris in a detailed manner and to model only in a simplistic manner the heat transfer from porous debris. In order to advance beyond the simplistic modeling for porous debris, designs are developed for detailed calculations of heat transfer and flow losses in porous debris. Correlations are identified for convective heat transfer in porous debris for the following modes of heat transfer; (1) forced convection to liquid, (2) forced convection to gas, (3) nucleate boiling, (4) transition boiling, and (5) film boiling. Interphase heat transfer is modeled in an approximate ma nner. Designs are described for models to calculate the flow losses and interphase drag of fluid flowing through the interstices of the porous debris, and to apply these variables in the momentum equations in the RELAP5 part of the code. Since the models for heat transfer and flow losses in porous debris in the lower head are designed for general application, a design is also described for implementation of these models to the analysis of porous debris in the core region. A test matrix is proposed for assessing the capability of the implemented models to calculate the heat transfer and flow losses in porous debris. The implementation of the models described in this report is expected to improve the COUPLE code calculation of the temperature distribution in porous debris and in the lower head that supports the debris. The implementation of these models is also expected to improve the calculation of the temperature and flow distribution in porous debris in the core region.

  17. Brain Response to Primary Blast Wave Using Validated Finite Element Models of Human Head and Advanced Combat Helmet

    PubMed Central

    Zhang, Liying; Makwana, Rahul; Sharma, Sumit

    2013-01-01

    Blast-induced traumatic brain injury has emerged as a “signature injury” in combat casualty care. Present combat helmets are designed primarily to protect against ballistic and blunt impacts, but the current issue with helmets is protection concerning blasts. In order to delineate the blast wave attenuating capability of the Advanced Combat Helmet (ACH), a finite element (FE) study was undertaken to evaluate the head response against blast loadings with and without helmet using a partially validated FE model of the human head and ACH. Four levels of overpressures (0.27–0.66 MPa) from the Bowen’s lung iso-damage threshold curves were used to simulate blast insults. Effectiveness of the helmet with respect to head orientation was also investigated. The resulting biomechanical responses of the brain to blast threats were compared for human head with and without the helmet. For all Bowen’s cases, the peak intracranial pressures (ICP) in the head ranged from 0.68 to 1.8 MPa in the coup cortical region. ACH was found to mitigate ICP in the head by 10–35%. Helmeted head resulted in 30% lower average peak brain strains and product of strain and strain rate. Among three blast loading directions with ACH, highest reduction in peak ICP (44%) was due to backward blasts whereas the lowest reduction in peak ICP and brain strains was due to forward blast (27%). The biomechanical responses of a human head to primary blast insult exhibited directional sensitivity owing to the different geometry contours and coverage of the helmet construction and asymmetric anatomy of the head. Thus, direction-specific tolerances are needed in helmet design in order to offer omni-directional protection for the human head. The blasts of varying peak overpressures and durations that are believed to produce the same level of lung injury produce different levels of mechanical responses in the brain, and hence “iso-damage” curves for brain injury are likely different than the Bowen

  18. Brain response to primary blast wave using validated finite element models of human head and advanced combat helmet.

    PubMed

    Zhang, Liying; Makwana, Rahul; Sharma, Sumit

    2013-01-01

    Blast-induced traumatic brain injury has emerged as a "signature injury" in combat casualty care. Present combat helmets are designed primarily to protect against ballistic and blunt impacts, but the current issue with helmets is protection concerning blasts. In order to delineate the blast wave attenuating capability of the Advanced Combat Helmet (ACH), a finite element (FE) study was undertaken to evaluate the head response against blast loadings with and without helmet using a partially validated FE model of the human head and ACH. Four levels of overpressures (0.27-0.66 MPa) from the Bowen's lung iso-damage threshold curves were used to simulate blast insults. Effectiveness of the helmet with respect to head orientation was also investigated. The resulting biomechanical responses of the brain to blast threats were compared for human head with and without the helmet. For all Bowen's cases, the peak intracranial pressures (ICP) in the head ranged from 0.68 to 1.8 MPa in the coup cortical region. ACH was found to mitigate ICP in the head by 10-35%. Helmeted head resulted in 30% lower average peak brain strains and product of strain and strain rate. Among three blast loading directions with ACH, highest reduction in peak ICP (44%) was due to backward blasts whereas the lowest reduction in peak ICP and brain strains was due to forward blast (27%). The biomechanical responses of a human head to primary blast insult exhibited directional sensitivity owing to the different geometry contours and coverage of the helmet construction and asymmetric anatomy of the head. Thus, direction-specific tolerances are needed in helmet design in order to offer omni-directional protection for the human head. The blasts of varying peak overpressures and durations that are believed to produce the same level of lung injury produce different levels of mechanical responses in the brain, and hence "iso-damage" curves for brain injury are likely different than the Bowen curves for lung

  19. Investigation of tDCS volume conduction effects in a highly realistic head model

    NASA Astrophysics Data System (ADS)

    Wagner, S.; Rampersad, S. M.; Aydin, Ü.; Vorwerk, J.; Oostendorp, T. F.; Neuling, T.; Herrmann, C. S.; Stegeman, D. F.; Wolters, C. H.

    2014-02-01

    Objective. We investigate volume conduction effects in transcranial direct current stimulation (tDCS) and present a guideline for efficient and yet accurate volume conductor modeling in tDCS using our newly-developed finite element (FE) approach. Approach. We developed a new, accurate and fast isoparametric FE approach for high-resolution geometry-adapted hexahedral meshes and tissue anisotropy. To attain a deeper insight into tDCS, we performed computer simulations, starting with a homogenized three-compartment head model and extending this step by step to a six-compartment anisotropic model. Main results. We are able to demonstrate important tDCS effects. First, we find channeling effects of the skin, the skull spongiosa and the cerebrospinal fluid compartments. Second, current vectors tend to be oriented towards the closest higher conducting region. Third, anisotropic WM conductivity causes current flow in directions more parallel to the WM fiber tracts. Fourth, the highest cortical current magnitudes are not only found close to the stimulation sites. Fifth, the median brain current density decreases with increasing distance from the electrodes. Significance. Our results allow us to formulate a guideline for volume conductor modeling in tDCS. We recommend to accurately model the major tissues between the stimulating electrodes and the target areas, while for efficient yet accurate modeling, an exact representation of other tissues is less important. Because for the low-frequency regime in electrophysiology the quasi-static approach is justified, our results should also be valid for at least low-frequency (e.g., below 100 Hz) transcranial alternating current stimulation.

  20. A rare avascolar osteonecrosis of the knee related to biphosphonate treatment in a patient with metastatic breast cancer.

    PubMed

    Rossi, Lorenzo; Lascio, Simona Di; Kouros, Michail; Pagani, Olivia

    2015-01-01

    Bisphosphonates are widely used both in the multidisciplinary management of bone metastases, especially osteolytic lesions from solid tumors or multiple myeloma, and of osteoporosis.Aseptic osteonecrosis, especially of the jaw, is among the well-known, although uncommon, side effects of bisphosphonates. Osteonecrosis of other bones has been very rarely reported with the use of bisphosphonates.We describe a rare case of osteonecrosis of the distal femur associated with the use of bisphosphonates in a 74 years old female patient with metastatic breast cancer. PMID:26406544

  1. An Ex Vivo Model in Human Femoral Heads for Histopathological Study and Resonance Frequency Analysis of Dental Implant Primary Stability

    PubMed Central

    Hernández-Cortés, Pedro; Galindo-Moreno, Pablo; Catena, Andrés; Ortega-Oller, Inmaculada; Salas-Pérez, José; Gómez-Sánchez, Rafael; Aguilar, Mariano; Aguilar, David

    2014-01-01

    Objective. This study was designed to explore relationships of resonance frequency analysis (RFA)—assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. Material and Methods. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. Results. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). Conclusion. Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies. PMID:24995307

  2. A Multiple Model Approach to Track Head Orientation With Delta Quaternions.

    PubMed

    Himberg, Henry; Motai, Yuichi; Bradley, Arthur

    2013-02-01

    Virtual reality and augmented reality environments using helmet-mounted displays create a sense of immersion by closely coupling user head motion to display content. Delays in the presentation of visual information can destroy the sense of presence in the simulation environment when it causes a lag in the display response to user head motion. The effect of display lag can be minimized by predicting head orientation, allowing the system to have sufficient time to counteract the delay. In this paper, anew head orientation prediction technique is proposed that uses a multiple delta quaternion (DQ) extended Kalman filter to track angular head velocity and angular head acceleration. This method is independent of the device used for orientation measurement, relying on quaternion orientation as the only measurement data. A new orientation prediction algorithm is proposed that estimates future head orientation as a function of the current orientation measurement and a predicted change in orientation, using the velocity and acceleration estimates. Extensive experimentation shows that the new method improves head orientation prediction when compared to single filter DQ prediction. PMID:22692926

  3. Osteonecrosis of the jaw (ONJ): diagnosis and management in 2015.

    PubMed

    Khan, A; Morrison, A; Cheung, A; Hashem, W; Compston, J

    2016-03-01

    Osteonecrosis of the jaw (ONJ) has been associated with the use of aminobisphosphonates and denosumab. The vast majority (>90%) of cases occur in the oncology patient population receiving high doses of intravenous bisphosphonates or subcutaneous denosumab. The incidence of ONJ in the osteoporosis patient population is very low and is estimated at 1-90 per 100,000 patient-years of exposure. In the oncology patient population the incidence appears to be related to dose and duration of exposure, and prevalence has been estimated to be as high as 18.6%. A number of risk factors in addition to antiresorptive therapy have been identified. These include the presence of periodontal disease, oral surgical procedures with extractions or implants, radiation therapy, chemotherapy, diabetes, glucocorticoid use, and smoking. Antiangiogenic agents appear to contribute to the risk of ONJ, however, data at this time are limited and further evidence is required prior to confirming a causal relationship. ONJ may be prevented with optimization of oral hygiene, the use of oral antimicrobial mouth rinses, as well as systemic antibiotic therapy. Individuals not responding to conservative management or in the advanced stages of ONJ may be considered for surgery, as data over the past several years have demonstrated surgical success in this patient population. Case reports have indicated that teriparatide may enhance healing. A number of experimental therapies are being evaluated and include the use of bone marrow stem cell intralesional transplantation, local application of platelet-derived growth factor, hyperbaric oxygen, tissue grafting, and low-level laser therapy. This paper summarizes the current research as well as the international consensus on the diagnosis and management of ONJ. PMID:26493811

  4. A Modeling of Cerebral Blood Flow Changes due to Head Motion for fNIRS

    NASA Astrophysics Data System (ADS)

    Takahashi, Kosuke; Tanaka, Takayuki; Nara, Hiroyuki; Kaneko, Shun'ichi; Inoue, Masao; Shimizu, Shunji; Kojima, Satoru

    2013-04-01

    A method is proposed for measuring brain activity during exercises involving head motion by using functional near-infrared spectroscopy (fNIRS), which investigates cerebral hemodynamics. Obtaining measurements during exercise is difficult because cerebral blood flow changes due to the head motion component (HMC), in addition to neural activity. HMC is an undesirable artifact in the measurement of hemodynamic response caused by neural activity, and as such, it must be estimated and eliminated. In our experiments, cerebral blood flow and head motion were measured during repeated passive forward bending of the subjects. Head motion was measured by 3-D motion capture, and HMC was estimated by deriving a relation between head motion and cerebral blood flow, where the pitch angle was found to be suitable for estimating HMC. In this research, an assumption was made that cerebral blood flow caused by neural activity and that caused by postural change were additive, and thus HMC was eliminated by subtraction.

  5. SU-C-BRF-03: PCA Modeling of Anatomical Changes During Head and Neck Radiation Therapy

    SciTech Connect

    Chetvertkov, M; Kim, J; Siddiqui, F; Kumarasiri, A; Chetty, I; Gordon, J

    2014-06-15

    Purpose: To develop principal component analysis (PCA) models from daily cone beam CTs (CBCTs) of head and neck (H and N) patients that could be used prospectively in adaptive radiation therapy (ART). Methods: : For 7 H and N patients, Pinnacle Treatment Planning System (Philips Healthcare) was used to retrospectively deformably register daily CBCTs to the planning CT. The number N of CBCTs per treatment course ranged from 14 to 22. For each patient a PCA model was built from the deformation vector fields (DVFs), after first subtracting the mean DVF, producing N eigen-DVFs (EDVFs). It was hypothesized that EDVFs with large eigenvalues represent the major anatomical deformations during the course of treatment, and that it is feasible to relate each EDVF to a clinically meaningful systematic or random change in anatomy, such as weight loss, neck flexion, etc. Results: DVFs contained on the order of 3×87×87×58=1.3 million scalar values (3 times the number of voxels in the registered volume). The top 3 eigenvalues accounted for ∼90% of variance. Anatomical changes corresponding to an EDVF were evaluated by generating a synthetic DVF, and applying that DVF to the CT to produce a synthetic CBCT. For all patients, the EDVF for the largest eigenvalue was interpreted to model weight loss. The EDVF for other eigenvalues appeared to represented quasi-random fraction-to-fraction changes. Conclusion: The leading EDVFs from single-patient PCA models have tentatively been identified with weight loss changes during treatment. Other EDVFs are tentatively identified as quasi-random inter-fraction changes. Clean separation of systematic and random components may require further work. This work is expected to facilitate development of population-based PCA models that can be used to prospectively identify significant anatomical changes, such as weight loss, early in treatment, triggering replanning where beneficial.

  6. A case of nasal septal abscess caused by medication related osteonecrosis in breast cancer patient.

    PubMed

    Maeda, Mayuka; Matsunobu, Takeshi; Kurioka, Takaomi; Kurita, Akihiro; Shiotani, Akihiro

    2016-02-01

    Antiresorptive drugs have been widely used to treat patients with hypercalcemia caused by malignancy, bone metastasis, multiple myeloma, and osteoporosis. However, it is well known that antiresorptive drugs can cause osteonecrosis of the jaw (ONJ). Herein, we report a rare case of nasal septal abscess caused by medication related osteonecrosis of the jaw (MRONJ) in a breast cancer patient. A 69-year-old woman was referred to our clinic for evaluation of nasal obstruction. Physical examination revealed a cherry-like swelling of the nasal mucosa emanating from the septum that obstructed both nasal cavities and a fistulous tract showing pus discharge after extraction of the bilateral maxillary central incisors (MCI) and the right maxillary lateral incisor (MLI). Computed tomography and panoramic radiography revealed extensive osteonecrosis of the maxilla and swelling of the nasal mucosa. The clinical diagnosis was nasal septal abscess caused by osteonecrosis of the maxilla. Surgical procedure was undertaken for this case. An indwelling drain was placed in the oral cavity, and sequestrectomy was performed with incision and drainage of the anterior portion of left nasal septum. The patient was doing well at the 7-month follow-up. The patient had a medical history of breast cancer with bone, lung, liver metastases, and had received intravenous bisphosphonate, which is one of the antiresorptive medicines, over the past 4 years. We suspect that this history played an important role in MRONJ induced nasal septal abscess. PMID:26775849

  7. Bisphosphonates, vitamin D, parathyroid hormone, and osteonecrosis of the jaw. Could there be a missing link?

    PubMed Central

    Leizaola-Cardesa, Ignacio-Osoitz; Aguilar-Salvatierra, Antonio; Gonzalez-Jaranay, Maximino; Moreu, Gerardo; Sala-Romero, María-José

    2016-01-01

    It is estimated that over 190 million bisphosphonates have been prescribed worldwide. But this drug can produce adverse effects, of which osteonecrosis of the jaw and severe hypocalcemia are the most serious. It is evident that bisphosphonate administration affects multiple and diverse biochemical mediators related to bone metabolism. This review of literature investigates four basic parameters in patients treated with bisphosphonates - parathyroid hormone (PTH), bisphosphonates, vitamin D, calcium, and jaw osteonecrosis - which are fundamental for assessing bone metabolism and so the efficacy and correct use of the drug. The imbalances generated by vitamin D and calcium deficiencies, together with their multiple systemic repercussions, have been widely researched but the outcomes of these imbalances in relation to bisphosphonate administration are not well known, and some research has indicated that they may be associated with osteonecrosis of the jaw (ONJ). The present review set out to explain the functioning of bone metabolism, the importance of different chemical mediators, the imbalances produced by incorrect use of this drug, in order to forewarn against the possible relation of these parameters with ONJ, whose physiopathology remains unknown. Medical and dental clinics should keep detailed anamneses of the use of vitamin D and calcium supplements, as it is of vital importance to maintain their correct levels in blood, given that these are related to ONJ as well as other adverse effects; this procedure is also necessary in order to ensure the correct use of the drug. Key words:Bisphosphonate-related osteonecrosis of the jaw, vitamin D, parathyroid hor PMID:26827062

  8. Phototheranostic Porphyrin Nanoparticles Enable Visualization and Targeted Treatment of Head and Neck Cancer in Clinically Relevant Models

    PubMed Central

    Muhanna, Nidal; Jin, Cheng S; Huynh, Elizabeth; Chan, Harley; Qiu, Yi; Jiang, Wenlei; Cui, Liyang; Burgess, Laura; Akens, Margarete K; Chen, Juan; Irish, Jonathan C; Zheng, Gang

    2015-01-01

    Head and neck cancer is the fifth most common type of cancer worldwide and remains challenging for effective treatment due to the proximity to critical anatomical structures in the head and neck region, which increases the probability of toxicity from surgery and radiotherapy, and therefore emphasizes the importance of maximizing the targeted ablation. We have assessed the effectiveness of porphysome nanoparticles to enhance fluorescence and photoacoustic imaging of head and neck tumors in rabbit and hamster models. In addition, we evaluated the effectiveness of this agent for localized photothermal ablative therapy of head and neck tumors. We have demonstrated that porphysomes not only enabled fluorescence and photoacoustic imaging of buccal and tongue carcinomas, but also allowed for complete targeted ablation of these tumors. The supremacy of porphysome-enabled photothermal therapy over surgery to completely eradicate primary tumors and metastatic regional lymph node while sparing the adjacent critical structures' function has been demonstrated for the first time. This study represents a novel breakthrough that has the potential to revolutionize our approach to tumor diagnosis and treatment in head and neck cancer and beyond. PMID:26681987

  9. Parametric transfer function analysis and modeling of blood flow autoregulation in the optic nerve head

    PubMed Central

    Yu, Jintao; Liang, Yi; Thompson, Simon; Cull, Grant; Wang, Lin

    2014-01-01

    The aim of the study was to establish a parametric transfer function to describe the relationship between ocular perfusion pressure (OPP) and blood flow (BF) in the optic nerve head (ONH). A third-order parametric theoretical model was proposed to describe the ONH OPP-BF relationship within the lower OPP range of the autoregulation curve (< 80 mmHg) based on experimentally induced BF response to a rapid intraocular pressure (IOP) increase in 6 rhesus monkeys. The theoretical and actual data fitted well and suggest that this parametric third-order transfer function can effectively describe both the linear and nonlinear feature in dynamic and static autoregulation in the ONH within the OPP range studied. It shows that the BF autoregulation fully functions when the OPP was > 40 mmHg and becomes incomplete when the OPP was < 40 mmHg. This model may be used to help investigating the features of autoregulation in the ONH under different experimental conditions. PMID:24665355

  10. Telomere dysfunction promotes metastasis in a Terc null mouse model of head and neck cancer

    PubMed Central

    Bojovic, Bojana; Crowe, David L.

    2011-01-01

    Squamous cell carcinoma arises from highly proliferative basal layer epithelial cells which normally divide for a short time before detaching from the basement membrane and undergoing terminal differentiation. Basal layer cells in stratified epithelia express the reverse transcriptase known as telomerase. Most human cells do not express telomerase and therefore are subject to loss of telomeric DNA with age due to the inability of lagging strand synthesis to completely replicate chromosomal ends. Late generation telomerase deficient mice exhibit signs of premature aging including reduced function of proliferating cellular compartments. We examined development of squamous cell carcinoma in a telomerase deficient murine background with long and short telomeres. G1 Terc−/− mice (long telomeres) had fewer lymph node metastases which correlated with increased numbers of apoptotic cells in these tumors compared to wild type mice. However, G5 Terc−/− mice with short telomeres had increased metastatic tumor burden similar to wild type mice. This increased metastasis correlated with genomic instability and aneuploidy in tumor cells from G5 Terc−/− mice. A number of similarities with human SCC were noted in the mouse model, and dramatic differences in global gene expression profiles were demonstrated between primary and metastatic tumors. We concluded that telomere shortening promotes metastatic tumor development in a Terc null mouse model of head and neck cancer. PMID:21593138

  11. Impact of Model Uncertainty Description on Assimilating Hydraulic Head into the MIKE-SHE Distributed Hydrological Model

    NASA Astrophysics Data System (ADS)

    Zhang, D.; Madsen, H.; Ridler, M. E.; Rasmussen, J.; Refsgaard, J.; Jensen, K.

    2013-12-01

    Catchment-scale hydrological models are used as prediction tools to solve major challenges in water resources management. The reliability of hydrological model predictions is inevitably affected by the amount of information available to set up and calibrate the model. Data assimilation (DA) which combines complementary information from measurements and models has proven to be a powerful and promising tool in numerous research studies to improve model predictions. Especially, the ensemble Kalman filter (EnKF) which is a popular sequential data assimilation technique, has been extensively studied in the earth sciences for assimilating in-situ measurements and remote sensing data. However, one of the major challenges in data assimilation to optimally combine model and measurements is the description of model uncertainty. Only few studies have been reported for defining appropriate model uncertainty in hydrological DA. Modeling uncertainties can be conceptually different in different applications. Traditionally, model uncertainty is represented by parameter uncertainty with corresponding parameter statistics determined by inverse modeling. In most hydrological DA applications, however, model uncertainty is defined by experience using simple statistical descriptions of different uncertainty sources. In this work, both the uncertainty derived from inverse modeling and from empirical knowledge are used and analyzed. A combination of parameter-based, forcing-based and state-based model error is implemented in the EnKF framework for assimilating groundwater hydraulic heads into a catchment-scale model of the Karup Catchment in Denmark using the distributed and integrated hydrological model MIKE SHE. A series of synthetic identical twin experiments are carried out to analyze the impact of different model error assumptions on the feasibility and efficiency of the assimilation. The optimality of the EnKF underlying twin test provides possibilities to diagnose model error

  12. Applying DTI white matter orientations to finite element head models to examine diffuse TBI under high rotational accelerations.

    PubMed

    Colgan, Niall C; Gilchrist, Michael D; Curran, Kathleen M

    2010-12-01

    The in-vivo mechanical response of neural tissue during impact loading of the head is simulated using geometrically accurate finite element (FE) head models. However, current FE models do not account for the anisotropic elastic material behaviour of brain tissue. In soft biological tissue, there is a correlation between internal microscopic structure and macroscopic mechanical properties. Therefore, constitutive equations are important for the numerical analysis of the soft biological tissues. By exploiting diffusion tensor techniques the anisotropic orientation of neural tissue is incorporated into a non-linear viscoelastic material model for brain tissue and implemented in an explicit FE analysis. The viscoelastic material parameters are derived from published data and the viscoelastic model is used to describe the mechanical response of brain tissue. The model is formulated in terms of a large strain viscoelastic framework and considers non-linear viscous deformations in combination with non-linear elastic behaviour. The constitutive model was applied in the University College Dublin brain trauma model (UCDBTM) (i.e. three-dimensional finite element head model) to predict the mechanical response of the intra-cranial contents due to rotational injury. PMID:20869383

  13. Head-Down Tilt with Balanced Traction as a Model for Simulating Spinal Acclimation to Microgravity

    NASA Technical Reports Server (NTRS)

    Ballard, R. E.; Styf, J. R.; Watenpaugh, D. E.; Fechner, K.; Haruna, Y.; Kahan, N. J.; Hargens, A. R.

    1994-01-01

    Astronauts experience total body height increases of 4 to 7 cm in microgravity. Thus, stretching of the spinal cord, nerve roots, and muscular and ligamentous tissues may be responsible for the hyperreflexia, back pain, and muscular atrophy associated with exposure to microgravity. Axial compression of the spine makes 6 deg. head-down tilt (HDT) an unsuitable model for spinal acclimation to microgravity. However, this axial compression may be counteracted by balanced traction consisting of 10% body weight (sin 6 deg. = 0.1) applied to the legs. Six healthy male subjects underwent 3 days each of 60 HDT with balanced traction and horizontal bed rest (HBR), with a 2 week recovery period between treatments. Total body and spine length, lumbar disc height, back pain, erector spinae intramuscular pressure, and ankle joint torque were measured before, during and after each treatment. Total body and spine (processes of L5 - C7) lengths increased significantly more during HDT with balanced traction (22 +/- 8 mm and 25 +/- 8 mm, respectively) than during HBR (16 +/- 4 mm and 14 +/- 9 mm, respectively). Back and leg pain were significantly greater during HDT with balanced traction than during HBR. The distance between the lower end plate of L4 and the upper endplate of S1, as measured by sonography, increased significantly in both treatments to the same degree (2.9 +/- 1.9 mm, HDT with balanced traction; 3.3 +/- 1.5 mm, HBR). Intramuscular pressure of the erector spinae muscles and maximal ankle joint torque were unaltered with both models. While neither model increased height to the magnitude observed in microgravity, HDT with balanced traction may be a better model for simulating the body lengthening and back pain experienced in microgravity.

  14. Impact of Full-Day Head Start Prekindergarten Class Model on Student Academic Performance, Cognitive Skills, and Learning Behaviors by the End of Grade 2. Evaluation Brief

    ERIC Educational Resources Information Center

    Zhao, Huafang; Modarresi, Shahpar

    2013-01-01

    This brief describes the impact of the Montgomery County (Maryland) Public Schools (MCPS) 2007-2008 full-day Head Start prekindergarten (pre-K) class model on student academic performance, cognitive skills, and learning behaviors by the end of Grade 2. This is the fourth impact study of the MCPS full-day Head Start pre-K class model. The following…

  15. Osteonecrosis of the Torus Palatinus in the Setting of Long-Term Oral Bisphosphonate Use--A Case Report.

    PubMed

    Ryan, Joshua L; Larson, Eric

    2016-01-01

    Bisphosphonates are medications used orally and intravenously for a variety of conditions including cancer metastatic to bone, hypercalcemia of malignancy, Paget's disease and osteoporosis. Osteonecrosis of the jaw has been related to bisphosphonate use. Osteonecrosis of the jaw most commonly occurs in the setting of intravenous bisphosphonate use and concomitant dental work or trauma. Oral bisphosphonates have much less risk of osteonecrosis of the jaw. We present an interesting case of a patient on an oral bisphosphonate for an extended period of time (nine years), with a torus palatinus, who burned her palate while eating a slice of pizza. Over six months later, she presented with an area of denuded bone and diagnosis consistent with osteonecrosis of the torus palatinus. PMID:26882578

  16. Concept, diagnosis and classification of bisphosphonate-associated osteonecrosis of the jaws. A review of the literature

    PubMed Central

    Bagan, Jose V.

    2016-01-01

    Background Bisphosphonates (BPs) and other antiresorptive agents such as denosumab are widely prescribed for the treatment of osteoporosis and are also used in patients with multiple myeloma and metastatic breast or prostate cancer for avoiding bone reabsorption and fractures that result in increased morbidity-mortality among such individuals. Material and Methods We made a bibliographic search to analyze the concept, diagnosis and the different classifications for bisphosphonate-associated osteonecrosis of the jaws. Results Osteonecrosis of the jaws (ONJ) is an important complication of exposure to BPs or other antiresorptive agents, and although its prevalence is low, it can pose management problems. The definition, diagnosis and classification of osteonecrosis have evolved since Marx reported the first cases in 2003. Conclusions The present study offers a literature review and update on the existing diagnostic methods and classification of the disorder, with a view to facilitating earlier and more effective treatment. Key words:Osteonecrosis, jaws, bisphosphonates. PMID:26827066

  17. Energy Metabolism in a Matched Model of Radiation Resistance for Head and Neck Squamous Cell Cancer

    PubMed Central

    Mims, Jade; Bansal, Nidhi; Bharadwaj, Manish S.; Chen, Xiaofei; Molina, Anthony J.; Tsang, Allen W.; Furdui, Cristina M.

    2015-01-01

    While radiation therapy is commonly used for treating cancer, radiation resistance can limit long-term control of the disease. In this study, we investigated the reprogramming of the energy metabolism in radiosensitive and radioresistant head and neck squamous cell carcinomas (HNSCC) using a preclinical matched model of radiation resistance. Our investigation found that radioresistant rSCC-61 cells: 1. They display increased glucose uptake and decreased fatty acid uptake; 2. They deviate from the classical Warburg effect by diverting the glycolytic flux into the pentose phosphate pathway; 3. They are more dependent on glucose than glutamine metabolism to support growth; 4. They have decreased mitochondrial oxidative phosphorylation; 5. They have enhanced fatty acid biosynthesis by increasing the expression of fatty acid synthase; and 6. They utilize endogenous fatty acids to meet the energy demands for proliferation. Inhibition of fatty acid synthase with orlistat or FASN siRNA resulted in increased cytotoxicity and sensitivity to radiation in rSCC-61 cells. These results demonstrate the potential of combination therapy using radiation and orlistat or other inhibitors of lipid and energy metabolism for treating radiation resistance in HNSCC. PMID:25738895

  18. Monte Carlo modeling of light propagation in the human head for applications in sinus imaging

    NASA Astrophysics Data System (ADS)

    Cerussi, Albert E.; Mishra, Nikhil; You, Joon; Bhandarkar, Naveen; Wong, Brian

    2015-03-01

    Sinus blockages are a common reason for physician visits, affecting one out of seven people in the United States, and often require medical treatment. Diagnosis in the primary care setting is challenging because symptom criteria (via detailed clinical history) plus objective imaging [computed tomography (CT) or endoscopy] are recommended. Unfortunately, neither option is routinely available in primary care. We previously demonstrated that low-cost near-infrared (NIR) transillumination correlates with the bulk findings of sinus opacity measured by CT. We have upgraded the technology, but questions of source optimization, anatomical influence, and detection limits remain. In order to begin addressing these questions, we have modeled NIR light propagation inside a three-dimensional adult human head constructed via CT images using a mesh-based Monte Carlo algorithm (MMCLAB). In this application, the sinus itself, which when healthy is a void region (e.g., nonscattering), is the region of interest. We characterize the changes in detected intensity due to clear (i.e., healthy) versus blocked sinuses and the effect of illumination patterns. We ran simulations for two clinical cases and compared simulations with measurements. The simulations presented herein serve as a proof of concept that this approach could be used to understand contrast mechanisms and limitations of NIR sinus imaging.

  19. Monte Carlo modeling of light propagation in the human head for applications in sinus imaging

    PubMed Central

    Cerussi, Albert E.; Mishra, Nikhil; You, Joon; Bhandarkar, Naveen; Wong, Brian

    2015-01-01

    Abstract. Sinus blockages are a common reason for physician visits, affecting one out of seven people in the United States, and often require medical treatment. Diagnosis in the primary care setting is challenging because symptom criteria (via detailed clinical history) plus objective imaging [computed tomography (CT) or endoscopy] are recommended. Unfortunately, neither option is routinely available in primary care. We previously demonstrated that low-cost near-infrared (NIR) transillumination correlates with the bulk findings of sinus opacity measured by CT. We have upgraded the technology, but questions of source optimization, anatomical influence, and detection limits remain. In order to begin addressing these questions, we have modeled NIR light propagation inside a three-dimensional adult human head constructed via CT images using a mesh-based Monte Carlo algorithm (MMCLAB). In this application, the sinus itself, which when healthy is a void region (e.g., nonscattering), is the region of interest. We characterize the changes in detected intensity due to clear (i.e., healthy) versus blocked sinuses and the effect of illumination patterns. We ran simulations for two clinical cases and compared simulations with measurements. The simulations presented herein serve as a proof of concept that this approach could be used to understand contrast mechanisms and limitations of NIR sinus imaging. PMID:25781310

  20. Closed Head Injury in a Mouse Model Results in Molecular Changes Indicating Inflammatory Responses

    PubMed Central

    Israelsson, Charlotte; Wang, Yun; Kylberg, Annika; Pick, Chaim G.; Hoffer, Barry J.

    2009-01-01

    Abstract Cerebral gene expression changes in response to traumatic brain injury will provide useful information in the search for future trauma treatment. In order to characterize the outcome of mild brain injury, we studied C57BL/6J mice in a weight-drop, closed head injury model. At various times post-injury, mRNA was isolated from neocortex and hippocampus and transcriptional alterations were studied using quantitative reverse transcriptase PCR and gene array analysis. At three days post-injury, the results showed unilateral injury responses, both in neocortex and hippocampus, with the main effect seen on the side of the skull hit by the dropping weight. Upregulated transcripts encoded products characterizing reactive astrocytes, phagocytes, microglia, and immune-reactive cells. Markers for oligodendrocytes and T-cells were not altered. Notably, strong differences in the responses among individual mice were seen (e.g., for the Gfap transcript expressed by reactive astrocytes and the chemokine Ccl3 transcript expressed by activated microglial cells). In conclusion, mild TBI chiefly activates transcripts leading to tissue signaling, inflammatory processes, and chemokine signaling, as in focal brain injury, suggesting putative targets for drug development. PMID:19317611

  1. Modeling the Response of an Extraordinary Magnetoresistance (EMR) Magnetic Read-head

    NASA Astrophysics Data System (ADS)

    Ram-Mohan, L. R.; Moussa, J.; Solin, S. A.; Rowe, A. C. H.

    2002-03-01

    A finite element approach to the modeling of extraordinary magnetoresistance (EMR)(S.A. Solin et al., Science 289), 1530 (2000). in a 4-terminal circular semiconductor wafer with a central concentric metallic inhomogeneity, which acts as a metal shunt, was reported earlier.(J. Moussa, L. R. Ram-Mohan, J. Sullivan, T. Zhou, D. R. Hines, and S. A. Solin, Physical Review B64), 184410 (2001). Here we present new results on more complex externally shunted van der Pauw plate geometries(T. Zhou, D.R. Hines and S.A. Solin, Appl. Phys. Letter 78), 667 (2001). for the semiconductor/metal shunt structures. The response at the voltage leads is evaluated for a constant current through the two outer leads in a 4-contact arrangement, and the results suggest geometry-dependent variations to the EMR as the shunt geometry is altered. The effect of a localized magnetic field moving over a semiconductor bar attached to a metal shunt on the EMR is reported. The results demonstrate the significant advantages of the semiconductor/shunt arrangement over conventional magnetic structures such as those based on GMR and TMR used as read-heads in digital data storage systems.

  2. Closed traumatic brain injury model in sheep mimicking high-velocity, closed head trauma in humans.

    PubMed

    Grimmelt, A-C; Eitzen, S; Balakhadze, I; Fischer, B; Wölfer, J; Schiffbauer, H; Gorji, A; Greiner, C

    2011-08-01

    To date, there are only a few, non-evidence based, cerebroprotective therapeutic strategies for treatment and, accordingly, for prevention of secondary brain injuries following severe closed head trauma. In order to develop new therapy strategies, existing realistic animal models need to be advanced. The objective is to bridge standardized small animal models and actual patient medical care, since the results of experimental small animal studies often cannot be transferred to brain-injured humans. For improved standardization of high-velocity trauma, new trauma devices for initiating closed traumatic brain injury in sheep were developed. The following new devices were tested: 1. An anatomically shaped rubber bolt with an integrated oscillation absorber for prevention of skull fractures; 2. Stationary mounting of the bolt to guarantee stable experimental conditions; 3. Varying degrees of trauma severity, i. e., mild and severe closed traumatic brain injury, using different cartridges; and 4. Trauma analysis via high-speed video recording. Peritraumatic measurements of intracranial pressure, brain tissue pH, brain tissue oxygen, and carbon dioxide pressure, as well as neurotransmitter concentrations were performed. Cerebral injuries were documented with magnetic resonance imaging and compared to neuropathological results. Due to the new trauma devices, skull fractures were prevented. The high-speed video recording documented a realistic trauma mechanism for a car accident. Enhancement of extracellular glutamate, aspartate, and gamma amino butyric acid concentrations began 60 min after the trauma. Magnetic resonance imaging and neuropathological results showed characteristic injury patterns of mild, and severe, closed traumatic brain injury. The severe, closed traumatic brain injury group showed diffuse axonal injuries, traumatic subarachnoid hemorrhage, and hemorrhagic contusions with inconsistent distribution among the animals. The model presented here achieves

  3. Increased Prevalence of Bisphosphonate-Related Osteonecrosis of the Jaw with Vitamin D Deficiency in Rats

    PubMed Central

    Hokugo, Akishige; Christensen, Russell; Chung, Evelyn M; Sung, Eric C; Felsenfeld, Alan L; Sayre, James W; Garrett, Neal; Adams, John S; Nishimura, Ichiro

    2010-01-01

    Necrotic bone exposure in the oral cavity has recently been reported in patients treated with nitrogen-containing bisphosphonates as part of their therapeutic regimen for multiple myeloma or metastatic cancers to bone. It has been postulated that systemic conditions associated with cancer patients combined with tooth extraction may increase the risk of osteonecrosis of the jaw (ONJ). The objective of this study was to establish an animal model of bisphosphonate-related ONJ by testing the combination of these risk factors. The generation of ONJ lesions in rats resembling human disease was achieved under the confluence of intravenous injection of zoledronate (ZOL; 35 µg/kg every 2 weeks), maxillary molar extraction, and vitamin D deficiency [VitD(−)]. The prevalence of ONJ in the VitD(−)/ZOL group was 66.7%, which was significantly higher (p < .05, Fisher exact test) than the control (0%), VitD(−) (0%), and ZOL alone (14.3%) groups. Similar to human patients, rat ONJ lesions prolonged the oral exposure of necrotic bone sequestra and were uniquely associated with pseudoepitheliomatous hyperplasia. The number of terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate–biotin nick-end label–positive (TUNEL+) osteoclasts significantly increased on the surface of post–tooth extraction alveolar bone of the VitD(−)/ZOL group, where sustained inflammation was depicted by [18F]fluorodeoxyglucose micro-positron emission tomography (µPET). ONJ lesions were found to be associated with dense accumulation of mixed inflammatory/immune cells. These cells, composed of neutrophils and lymphocytes, appeared to juxtapose apoptotic osteoclasts. It is suggested that the pathophysiologic mechanism(s) underpinning ONJ may involve the interaction between bisphosphonates and compromised vitamin D functions in the realm of skeletal homeostasis and innate immunity. © 2010 American Society for Bone and Mineral Research. PMID:20200938

  4. High Prevalence of Prothrombotic Abnormalities in Multifocal Osteonecrosis

    PubMed Central

    Peris, Pilar; Reverter, Joan Carles; Espinosa, Gerard; Martinez-Ferrer, Angeles; Monegal, Ana; Monteagudo, Juan; Tàssies, Dolors; Guañabens, Nuria

    2013-01-01

    Abstract Multifocal or multiple osteonecrosis (ON), defined by the involvement of 3 or more anatomic sites, is unusual, being observed in only 3%–10% of patients diagnosed with ON. We report the clinical characteristics of a cohort of 29 patients with multifocal ON from a single center and evaluate the prevalence of associated prothrombotic abnormalities in 26 of these patients. We conducted a retrospective study of all patients diagnosed with multifocal ON evaluated in our institution during the last 20 years. We recorded clinical manifestations and underlying diagnoses. A wide thrombophilic profile was performed, including antithrombin, protein C, protein S, lupus anticoagulant, anticardiolipin antibodies, activated protein C resistance, factor V Leiden, mutation G-20210-A of the prothrombin gene, and factor VIII. Coagulation test results were compared with those in a healthy control group and a group of patients with history of lower-extremity deep venous thrombosis. The mean age of the patients was 49.2 ± 15 years (range, 28–81 yr). The mean number of ON localizations per patient was 5.2 ± 2.3 (range, 3–11). Hips were the most commonly affected joint (82%), followed by knees (58%), shoulders (37%), and ankles (13%). Most patients had an underlying disease process, and 12 of 25 (48%) patients had coagulation test abnormalities. The most common alterations were high factor VIII levels and antiphospholipid antibody (aPL) positivity in 24% and 20% of cases, respectively. These abnormalities were more prevalent in patients with multifocal ON compared with patients in the control groups. Sixty-one percent of patients had a history of corticosteroid treatment. Patients with coagulation abnormalities had a higher number of ON localizations per patient (6.5 ± 2.7 vs. 3.88 ± 0.8; p = 0.002) and a higher prevalence of atypical ON localizations (25% vs. 0%; p = 0.05). In conclusion, in the present cohort of patients with multifocal ON, 48% of the patients had at

  5. Feasibility of Primary Tumor Culture Models and Preclinical Prediction Assays for Head and Neck Cancer: A Narrative Review

    PubMed Central

    Dohmen, Amy J. C.; Swartz, Justin E.; Van Den Brekel, Michiel W. M.; Willems, Stefan M.; Spijker, René; Neefjes, Jacques; Zuur, Charlotte L.

    2015-01-01

    Primary human tumor culture models allow for individualized drug sensitivity testing and are therefore a promising technique to achieve personalized treatment for cancer patients. This would especially be of interest for patients with advanced stage head and neck cancer. They are extensively treated with surgery, usually in combination with high-dose cisplatin chemoradiation. However, adding cisplatin to radiotherapy is associated with an increase in severe acute toxicity, while conferring only a minor overall survival benefit. Hence, there is a strong need for a preclinical model to identify patients that will respond to the intended treatment regimen and to test novel drugs. One of such models is the technique of culturing primary human tumor tissue. This review discusses the feasibility and success rate of existing primary head and neck tumor culturing techniques and their corresponding chemo- and radiosensitivity assays. A comprehensive literature search was performed and success factors for culturing in vitro are debated, together with the actual value of these models as preclinical prediction assay for individual patients. With this review, we aim to fill a gap in the understanding of primary culture models from head and neck tumors, with potential importance for other tumor types as well. PMID:26343729

  6. Lithospheric Flexure and Sedimentary Basin Evolution: the Steer's Head Model Re-visited

    NASA Astrophysics Data System (ADS)

    Moore, J. D. P.; Watts, A. B.

    2015-12-01

    Backstripping studies of biostratigraphic data from deep wells show that sediment loading is one of the main factors controlling the subsidence and uplift history of sedimentary basins. Previous studies based on single layer models of elastic and viscoelastic plates overlying an inviscid fluid have shown that sediment loading, together with a tectonic subsidence that decreases exponentially with time, can explain the large-scale 'architecture' of rift-type basins and, in some cases, details of their internal stratigraphy such as onlap and offlap patterns. One problem with these so-called 'steer's head' models is that they were based on a simple rheological model in which the long-term strength of the lithosphere increased with thermal age. Recent oceanic flexure studies, however, reveal that the long-term strength of the lithosphere depends not only on thermal age, but also load age. We have used the thermal structure based on plate cooling models, together with recent experimentally-derived flow laws, to compute the viscosity structure of the lithosphere and a new analytical model to compute the flexure of a multilayer viscoelastic plate by a trapezoid-shaped sediment load at different times since basin initiation. If we define the nondimensional number Dw = τm/τt, where τm is the Maxwell time constant and τt is the thermal time constant, we find that for Dw << 1 the flexure approximates that of an elastic plate and an onlap pattern forms at the edge of basin (Fig. 1), whereas for Dw >> 1 the flexure approximates that of a viscoelastic plate and an offlap pattern develops (Fig. 2). Interestingly Dw ~ 1 produces a basin in which onlap dominates its early evolution while offlap dominates its later evolution and an unconformity separates the two different stratal patterns (Fig. 3). Therefore, when consideration is given to the fact that the long-term strength of the lithosphere depends on both thermal and load age we are able to produce stratal geometries that

  7. Lithospheric flexure and sedimentary basin evolution: depositional cycles in the steer's head model

    NASA Astrophysics Data System (ADS)

    Moore, James; Watts, Tony

    2016-04-01

    Backstripping studies of biostratigraphic data from deep wells show that sediment loading is one of the main factors controlling the subsidence and uplift history of sedimentary basins. Previous studies based on single layer models of elastic and viscoelastic plates overlying an inviscid fluid have shown that sediment loading, together with a tectonic subsidence that decreases exponentially with time, can explain the large-scale 'architecture' of rift-type basins and, in some cases, details of their internal stratigraphy such as onlap and offlap patterns. One problem with these so-called 'steer's head' models is that they were based on a simple rheological model in which the long-term strength of the lithosphere increased with thermal age. Recent oceanic flexure studies, however, reveal that the long-term strength of the lithosphere depends not only on thermal age, but also load age. We have used the thermal structure based on plate cooling models, together with recent experimentally-derived flow laws, to compute the viscosity structure of the lithosphere and a new analytical model to compute the flexure of a multilayer viscoelastic plate by a trapezoid-shaped sediment load at different times since basin initiation. The combination of basin subsidence and viscoelastic flexural response results in the fluctuation of the depositional surface with time. If we define the nondimensional number Dw= τm/τt, where τm is the Maxwell time constant and τt is the thermal time constant, we find that for Dw<<1 the flexure approximates that of an elastic plate and is dominated by "onlapping" stratigraphy which evolves through the sedimentary facies with a progressive deepening of the depositional surface. For Dw>>1 the flexure approximates that of a viscoelastic plate and is dominated by "offlapping" stratigraphy, with the basin edges evolving through shallow marine facies; though erosion late in the basin formation prevents much of this from being recorded in the stratigraphy

  8. Bisphosphonate-related osteonecrosis of jaw (BRONJ): diagnostic criteria and possible pathogenic mechanisms of an unexpected anti-angiogenic side effect

    PubMed Central

    2013-01-01

    Recently, bisphosphonates (BPs) have been widely used in medical practice as anti-resorptive agents owing to their anti-osteoclatic action. In addition, these compounds are also used for their analgesic action and their potential anti-tumour effect. Patients treated with BPs may subsequently develop osteonecrosis of the jaw or maxillary bone after minor local trauma including dental work, recently labelled as bisphosphonate osteonecrosis of jaw (BRONJ). However, the etiopathogenic mechanisms of this pathological condition are poorly understood. Although, several pathways have been proposed for BRONJ occurrence, no single model can explain all morphological changes observed at the macro- and microscopic level. Recent research suggests that BPs may promote an anti-angiogenic effect which contributes directly to the clinical features associated with BRONJ. Remarkably, the anti-angiogenic effect promoting BRONJ might be in keeping with the anti-neoplastic action of BPs. The current review, presents clinical diagnostic criteria. In addition, based on our own experience we describe the histopathological criteria for diagnosis of BRONJ and the possible pathways which may lead to this frustrating pathological condition. PMID:23316704

  9. Upward and inward displacements of the acetabular component increase stress on femoral head in single endoprothesis models

    PubMed Central

    Zhang, Zhiqi; Kang, Yan; Chen, Yi; Liao, Weiming

    2009-01-01

    The centre of rotation of the hip can be displaced in hip dysplasia and revision arthroplasty. This study examined the effect of artificial femoral head load after acetabular component displacement in total hip arthroplasty. Sixteen total hip arthroplasty models of human cadaver specimens were reconstructed, and under different acetabular component position, the load around the femoral head was evaluated by strain gages. The results showed that the load was higher in the same specimens when the cup was moved 2 mm inward or upward, especially after the cup was moved more than 6 mm, and the load had an increasing effect in the inward group. In the upward group, an increasing effect happened at 8 mm upward displacement, but the stress value decreased from 4 mm to 6 mm upward displacement. In the same moving distance, the stress of inward displacement is obviously higher than upward displacement. Altogether, the results suggested that for both inward displacement and upward displacement of the acetabular cup, the load around the femoral head increased gradually, while the distance of the inward displacement and the superior displacement was increased. The greater the displacement, the bigger the loading contact stress. The upward displacement caused less stress change on the femoral head. The stress of the 6 mm upward position was lower than nearby positions; perhaps this site represented a stress buffering zone. PMID:19424694

  10. Emulating the visual receptive-field properties of MST neurons with a template model of heading estimation

    NASA Technical Reports Server (NTRS)

    Perrone, J. A.; Stone, L. S.

    1998-01-01

    We have proposed previously a computational neural-network model by which the complex patterns of retinal image motion generated during locomotion (optic flow) can be processed by specialized detectors acting as templates for specific instances of self-motion. The detectors in this template model respond to global optic flow by sampling image motion over a large portion of the visual field through networks of local motion sensors with properties similar to those of neurons found in the middle temporal (MT) area of primate extrastriate visual cortex. These detectors, arranged within cortical-like maps, were designed to extract self-translation (heading) and self-rotation, as well as the scene layout (relative distances) ahead of a moving observer. We then postulated that heading from optic flow is directly encoded by individual neurons acting as heading detectors within the medial superior temporal (MST) area. Others have questioned whether individual MST neurons can perform this function because some of their receptive-field properties seem inconsistent with this role. To resolve this issue, we systematically compared MST responses with those of detectors from two different configurations of the model under matched stimulus conditions. We found that the characteristic physiological properties of MST neurons can be explained by the template model. We conclude that MST neurons are well suited to support self-motion estimation via a direct encoding of heading and that the template model provides an explicit set of testable hypotheses that can guide future exploration of MST and adjacent areas within the superior temporal sulcus.

  11. Head Injuries

    MedlinePlus

    ... injuries internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain Fortunately, most childhood falls or ... knock the brain into the side of the skull or tear blood vessels. Some internal head injuries ...

  12. Head Lice

    MedlinePlus

    ... or prescription products. Over-the-counter shampoos and lotions containing pyrethrin (one brand name: Rid) or permethrin ( ... commonly used to treat head lice. Shampoos and lotions that kill head lice contain pesticides and other ...

  13. Head MRI

    MedlinePlus

    ... the head; MRI - cranial; NMR - cranial; Cranial MRI; Brain MRI; MRI - brain; MRI - head ... tell your health care provider if you have: Brain aneurysm clips Certain types of artificial heart valves ...

  14. Modeling of ray paths of head waves on irregular interfaces in TOFD inspection for NDE.

    PubMed

    Ferrand, A; Darmon, M; Chatillon, S; Deschamps, M

    2014-09-01

    The TOFD (Time of Flight Diffraction) technique is a classical ultrasonic inspection method used in ultrasonic non-destructive evaluation (NDE). This inspection technique is based on an arrangement of two probes of opposite beam directions and allows a precise positioning and a quantitative evaluation of the size of cracks contained in the inspected material thanks to their edges diffraction echoes. Among the typical phenomena arising for such an arrangement, head waves, which propagate along the specimen surface and are chronologically the first waves reaching the receiver, are notably observed. Head wave propagation on planar surfaces in TOFD configurations is well known. However, realistic inspection configurations often involve components with irregular surfaces, like steel excavated specimens. Surface irregularity is responsible for numerous effects on the scattering of bulk waves, causing the melting of surface and bulk mechanisms in the head wave propagation. In order to extend the classical ray approach on these complex cases, a generic algorithm of ray tracing between interface points (GIRT) has been designed. With respect to time of flight minimization (i.e. the Generalized Fermat's Principle), ray paths can be computed by GIRT for different natures of waves scattered by the complex surfaces or by flaws. The head wave fronts computed by GIRT are notably in good agreement with FEM simulated results. This algorithm, based on pure kinematic analysis of waves propagation, represents a first step in the future development of a complete ray theory for head waves simulation on irregular interfaces. PMID:24388406

  15. Head lice.

    PubMed

    Devore, Cynthia D; Schutze, Gordon E

    2015-05-01

    Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2010 clinical report on head lice was published by the American Academy of Pediatrics, newer medications have been approved for the treatment of head lice. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting. PMID:25917986

  16. Two-Year versus One-Year Head Start Program Impact: Addressing Selection Bias by Comparing Regression Modeling with Propensity Score Analysis

    ERIC Educational Resources Information Center

    Leow, Christine; Wen, Xiaoli; Korfmacher, Jon

    2015-01-01

    This article compares regression modeling and propensity score analysis as different types of statistical techniques used in addressing selection bias when estimating the impact of two-year versus one-year Head Start on children's school readiness. The analyses were based on the national Head Start secondary dataset. After controlling for…

  17. Modelling an advanced ManPAD with dual band detectors and a rosette scanning seeker head

    NASA Astrophysics Data System (ADS)

    Birchenall, Richard P.; Richardson, Mark A.; Butters, Brian; Walmsley, Roy

    2012-01-01

    Man Portable Air Defence Systems (ManPADs) have been a favoured anti aircraft weapon since their appearance on the military proliferation scene in the mid 1960s. Since this introduction there has been a 'cat and mouse' game of Missile Countermeasures (CMs) and the aircraft protection counter counter measures (CCMs) as missile designers attempt to defeat the aircraft platform protection equipment. Magnesium Teflon Viton (MTV) flares protected the target aircraft until the missile engineers discovered the art of flare rejection using techniques including track memory and track angle bias. These early CCMs relied upon CCM triggering techniques such as the rise rate method which would just sense a sudden increase in target energy and assume that a flare CM had been released by the target aircraft. This was not as reliable as was first thought as aspect changes (bringing another engine into the field of view) or glint from the sun could inadvertently trigger a CCM when not needed. The introduction of dual band detectors in the 1980s saw a major advance in CCM capability allowing comparisons between two distinct IR bands to be made thus allowing the recognition of an MTV flare to occur with minimal false alarms. The development of the rosette scan seeker in the 1980s complemented this advancement allowing the scene in the missile field of view (FOV) to be scanned by a much smaller (1/25) instantaneous FOV (IFOV) with the spectral comparisons being made at each scan point. This took the ManPAD from a basic IR energy detector to a pseudo imaging system capable of analysing individual elements of its overall FOV allowing more complex and robust CCM to be developed. This paper continues the work published in [1,2] and describes the method used to model an advanced ManPAD with a rosette scanning seeker head and robust CCMs similar to the Raytheon Stinger RMP.

  18. Dipole estimation errors due to not incorporating anisotropic conductivities in realistic head models for EEG source analysis

    NASA Astrophysics Data System (ADS)

    Hallez, Hans; Staelens, Steven; Lemahieu, Ignace

    2009-10-01

    EEG source analysis is a valuable tool for brain functionality research and for diagnosing neurological disorders, such as epilepsy. It requires a geometrical representation of the human head or a head model, which is often modeled as an isotropic conductor. However, it is known that some brain tissues, such as the skull or white matter, have an anisotropic conductivity. Many studies reported that the anisotropic conductivities have an influence on the calculated electrode potentials. However, few studies have assessed the influence of anisotropic conductivities on the dipole estimations. In this study, we want to determine the dipole estimation errors due to not taking into account the anisotropic conductivities of the skull and/or brain tissues. Therefore, head models are constructed with the same geometry, but with an anisotropically conducting skull and/or brain tissue compartment. These head models are used in simulation studies where the dipole location and orientation error is calculated due to neglecting anisotropic conductivities of the skull and brain tissue. Results show that not taking into account the anisotropic conductivities of the skull yields a dipole location error between 2 and 25 mm, with an average of 10 mm. When the anisotropic conductivities of the brain tissues are neglected, the dipole location error ranges between 0 and 5 mm. In this case, the average dipole location error was 2.3 mm. In all simulations, the dipole orientation error was smaller than 10°. We can conclude that the anisotropic conductivities of the skull have to be incorporated to improve the accuracy of EEG source analysis. The results of the simulation, as presented here, also suggest that incorporation of the anisotropic conductivities of brain tissues is not necessary. However, more studies are needed to confirm these suggestions.

  19. Two particle model for studying the effects of space-charge force on strong head-tail instabilities

    NASA Astrophysics Data System (ADS)

    Chin, Yong Ho; Chao, Alexander Wu; Blaskiewicz, Michael M.

    2016-01-01

    In this paper, we present a new two particle model for studying the strong head-tail instabilities in the presence of the space-charge force. It is a simple expansion of the well-known two particle model for strong head-tail instability and is still analytically solvable. No chromaticity effect is included. It leads to a formula for the growth rate as a function of the two dimensionless parameters: the space-charge tune shift parameter (normalized by the synchrotron tune) and the wakefield strength, ϒ . The three-dimensional contour plot of the growth rate as a function of those two dimensionless parameters reveals stopband structures. Many simulation results generally indicate that a strong head-tail instability can be damped by a weak space-charge force, but the beam becomes unstable again when the space-charge force is further increased. The new two particle model indicates a similar behavior. In weak space-charge regions, additional tune shifts by the space-charge force dissolve the mode coupling. As the space-charge force is increased, they conversely restore the mode coupling, but then a further increase of the space-charge force decouples the modes again. This mode coupling/decoupling behavior creates the stopband structures.

  20. Numerical calculation of listener-specific head-related transfer functions and sound localization: Microphone model and mesh discretization

    PubMed Central

    Ziegelwanger, Harald; Majdak, Piotr; Kreuzer, Wolfgang

    2015-01-01

    Head-related transfer functions (HRTFs) can be numerically calculated by applying the boundary element method on the geometry of a listener’s head and pinnae. The calculation results are defined by geometrical, numerical, and acoustical parameters like the microphone used in acoustic measurements. The scope of this study was to estimate requirements on the size and position of the microphone model and on the discretization of the boundary geometry as triangular polygon mesh for accurate sound localization. The evaluation involved the analysis of localization errors predicted by a sagittal-plane localization model, the comparison of equivalent head radii estimated by a time-of-arrival model, and the analysis of actual localization errors obtained in a sound-localization experiment. While the average edge length (AEL) of the mesh had a negligible effect on localization performance in the lateral dimension, the localization performance in sagittal planes, however, degraded for larger AELs with the geometrical error as dominant factor. A microphone position at an arbitrary position at the entrance of the ear canal, a microphone size of 1 mm radius, and a mesh with 1 mm AEL yielded a localization performance similar to or better than observed with acoustically measured HRTFs. PMID:26233020

  1. A model of head-related transfer functions based on a state-space analysis

    NASA Astrophysics Data System (ADS)

    Adams, Norman Herkamp

    This dissertation develops and validates a novel state-space method for binaural auditory display. Binaural displays seek to immerse a listener in a 3D virtual auditory scene with a pair of headphones. The challenge for any binaural display is to compute the two signals to supply to the headphones. The present work considers a general framework capable of synthesizing a wide variety of auditory scenes. The framework models collections of head-related transfer functions (HRTFs) simultaneously. This framework improves the flexibility of contemporary displays, but it also compounds the steep computational cost of the display. The cost is reduced dramatically by formulating the collection of HRTFs in the state-space and employing order-reduction techniques to design efficient approximants. Order-reduction techniques based on the Hankel-operator are found to yield accurate low-cost approximants. However, the inter-aural time difference (ITD) of the HRTFs degrades the time-domain response of the approximants. Fortunately, this problem can be circumvented by employing a state-space architecture that allows the ITD to be modeled outside of the state-space. Accordingly, three state-space architectures are considered. Overall, a multiple-input, single-output (MISO) architecture yields the best compromise between performance and flexibility. The state-space approximants are evaluated both empirically and psychoacoustically. An array of truncated FIR filters is used as a pragmatic reference system for comparison. For a fixed cost bound, the state-space systems yield lower approximation error than FIR arrays for D>10, where D is the number of directions in the HRTF collection. A series of headphone listening tests are also performed to validate the state-space approach, and to estimate the minimum order N of indiscriminable approximants. For D = 50, the state-space systems yield order thresholds less than half those of the FIR arrays. Depending upon the stimulus uncertainty, a

  2. Deformation Prediction and Geometrical Modeling of Head and Neck Cancer Tumor: A Data Mining Approach

    NASA Astrophysics Data System (ADS)

    Azimi, Maryam

    Radiation therapy has been used in the treatment of cancer tumors for several years and many cancer patients receive radiotherapy. It may be used as primary therapy or with a combination of surgery or other kinds of therapy such as chemotherapy, hormone therapy or some mixture of the three. The treatment objective is to destroy cancer cells or shrink the tumor by planning an adequate radiation dose to the desired target without damaging the normal tissues. By using the pre-treatment Computer Tomography (CT) images, most of the radiotherapy planning systems design the target and assume that the size of the tumor will not change throughout the treatment course, which takes 5 to 7 weeks. Based on this assumption, the total amount of radiation is planned and fractionated for the daily dose required to be delivered to the patient's body. However, this assumption is flawed because the patients receiving radiotherapy have marked changes in tumor geometry during the treatment period. Therefore, there is a critical need to understand the changes of the tumor shape and size over time during the course of radiotherapy in order to prevent significant effects of inaccuracy in the planning. In this research, a methodology is proposed in order to monitor and predict daily (fraction day) tumor volume and surface changes of head and neck cancer tumors during the entire treatment period. In the proposed method, geometrical modeling and data mining techniques will be used rather than repetitive CT scans data to predict the tumor deformation for radiation planning. Clinical patient data were obtained from the University of Texas-MD Anderson Cancer Center (MDACC). In the first step, by using CT scan data, the tumor's progressive geometric changes during the treatment period are quantified. The next step relates to using regression analysis in order to develop predictive models for tumor geometry based on the geometric analysis results and the patients' selected attributes (age, weight

  3. Successful treatment of osteonecrosis-induced fractured mandible with teriparatide therapy: A case report

    PubMed Central

    Yao, Mayumi; Shimo, Tsuyoshi; Ono, Yuko; Obata, Kyoichi; Yoshioka, Norie; Sasaki, Akira

    2016-01-01

    Introduction The management of medication-related osteonecrosis of the jaw (MRONJ) is controversial. To date, there is no established treatment for cases of advanced stage 3 MRONJ osteoporosis in elderly patients. Presentation An 87-year-old osteoporotic woman with osteonecrosis-induced left mandible fracture related to minodronate therapy was referred to us for treatment. She had a vertebral compression fracture concurrently and had started subcutaneous injection of teriparatide. After 18 months of treatment with teriparatide the pathological mandible fracture was healed and functional recovery of the occlusion was obtained by complete dentures. Discussion Teriparatide may have a powerful anabolic effect on bone, and promote bone regeneration against pathologic mandible fracture induced by MRONJ. Conclusion Based upon these findings, teriparatide might be beneficial for advanced stage 3 MRONJ osteoporosis in elderly patients. PMID:26947555

  4. [The rare case of osteonecrosis of the jaws in a patient treated with bisphosphonates for osteoporosis].

    PubMed

    Lewandowski, Bogumił; Brodowski, Robert; Kość, Tomasz; Migut, Małgorzata; Wojnar, Joanna

    2016-01-01

    Bisphosphonates are used primarily in patients with bone metastases and osteoporosis One of the local complications, less well-known to doctors, associated with the use of bisphosphonates is osteonecrosis of the jaw (Biophosphatate Related osteonecrosis of the jaw--BRONJ). It affects approximately 1-10% of patients and may cause diagnostic difficulties because of its similarity to a primary focus in the bone. This issue can be encountered by the doctors of various specialties who use bisphosphonates. The purpose of this study is to present a case of the patient with BRONJ symptoms following the administration of bisphosphonate therapy, which can occur in the doctors practice. Concluding, maintaining good health of the oral cavity before starting the therapy reduces the incidence of BROKJ. Before starting bisphosphonate therapy, all patients should be referred to dental consultation to assess the potential foci of infection in the mouth. PMID:27120948

  5. A Case of Variegate Porphyria in Association With Coeliac Disease and Bisphosphonate Associated Dental Osteonecrosis

    PubMed Central

    Ogundipe, Olayinka A.

    2009-01-01

    This case describes an older patient with a rare diagnosis of variegate porphyria presenting with acute abdominal pains and bloating, intermittent loose stools and jaw pains following surgical repair of an osteoporotic hip fracture. She was noted to have acute hyponatraemia. All the abdominal symptoms and the hyponatraemia were initially attributed to an acute episode of variegate porphyria with an accompanying syndrome of inappropriate antidiuretic hormone secretion. However, following further evaluations necessitated by the incomplete resolution of the abdominal symptoms, it became apparent that some of the persisting symptoms were due to a concurrent and new presentation of serology positive coeliac disease. The jaw pains were established to be due to dental osteonecrosis in association with the use of bisphosphonate therapy for treatment of osteoporosis. The various symptoms and signs subsequently settled uneventfully following institution of appropriate management options for the various coexisting diagnoses. Keywords Abdominal pain; Abdominal bloating; Loose stools; Hyponatraemia; Variegate porphyria; Coeliac disease; Osteoporosis; Bisphosphonates; Osteonecrosis PMID:22481993

  6. Parenting Classes, Parenting Behavior, and Child Cognitive Development in Early Head Start: A Longitudinal Model

    ERIC Educational Resources Information Center

    Chang, Mido; Park, Boyoung; Kim, Sunha

    2009-01-01

    This study analyzed Early Head Start Research and Evaluation (EHSRE) study data, examining the effect of parenting classes on parenting behaviors and children's cognitive outcomes. The study analyzed three sets of dependent variables: parental language and cognitive stimulation, parent-child interactive activities, and the Bayley Mental…

  7. Models of Emotion Skills and Social Competence in the Head Start Classroom

    ERIC Educational Resources Information Center

    Spritz, Becky L.; Sandberg, Elisabeth Hollister; Maher, Edward; Zajdel, Ruth T.

    2010-01-01

    Research Findings: Fostering the social competence of at-risk preschoolers would be facilitated by knowing which of children's emotion skills are most salient to social outcomes. We examined the emotion skills and social competence of 44 children enrolled in a Head Start program. Emotion skills were examined in terms of children's emotional…

  8. Modelling the Species Distribution of Flat-Headed Cats (Prionailurus planiceps), an Endangered South-East Asian Small Felid

    PubMed Central

    Hearn, Andrew J.; Hesse, Deike; Mohamed, Azlan; Traeholdt, Carl; Cheyne, Susan M.; Sunarto, Sunarto; Jayasilan, Mohd-Azlan; Ross, Joanna; Shapiro, Aurélie C.; Sebastian, Anthony; Dech, Stefan; Breitenmoser, Christine; Sanderson, Jim; Duckworth, J. W.; Hofer, Heribert

    2010-01-01

    Background The flat-headed cat (Prionailurus planiceps) is one of the world's least known, highly threatened felids with a distribution restricted to tropical lowland rainforests in Peninsular Thailand/Malaysia, Borneo and Sumatra. Throughout its geographic range large-scale anthropogenic transformation processes, including the pollution of fresh-water river systems and landscape fragmentation, raise concerns regarding its conservation status. Despite an increasing number of camera-trapping field surveys for carnivores in South-East Asia during the past two decades, few of these studies recorded the flat-headed cat. Methodology/Principal Findings In this study, we designed a predictive species distribution model using the Maximum Entropy (MaxEnt) algorithm to reassess the potential current distribution and conservation status of the flat-headed cat. Eighty-eight independent species occurrence records were gathered from field surveys, literature records, and museum collections. These current and historical records were analysed in relation to bioclimatic variables (WorldClim), altitude (SRTM) and minimum distance to larger water resources (Digital Chart of the World). Distance to water was identified as the key predictor for the occurrence of flat-headed cats (>50% explanation). In addition, we used different land cover maps (GLC2000, GlobCover and SarVision LLC for Borneo), information on protected areas and regional human population density data to extract suitable habitats from the potential distribution predicted by the MaxEnt model. Between 54% and 68% of suitable habitat has already been converted to unsuitable land cover types (e.g. croplands, plantations), and only between 10% and 20% of suitable land cover is categorised as fully protected according to the IUCN criteria. The remaining habitats are highly fragmented and only a few larger forest patches remain. Conclusion/Significance Based on our findings, we recommend that future conservation efforts for

  9. An impulsive state feedback control model for releasing white-headed langurs in captive to the wild

    NASA Astrophysics Data System (ADS)

    Xu, Weijian; Chen, Lansun; Chen, Shidong; Pang, Guoping

    2016-05-01

    In this paper, an impulsive state feedback control model for releasing white-headed langurs in captive to the wild is investigated. By using the geometric theory of semi-continuous dynamic system, the method of successor functions and the analogue of the Poincare criterion, it is proved that under certain conditions the system has an order-1 periodic solution with trajectory asymptotical stability, and this periodic solution remains above some critical value. The theoretical results are verified by the numerical simulations. The conclusion is that simultaneously taking the measures of both population migration and artificial breeding can effectively protect wild white-headed langurs, so that the population can continue to survive and can avoid becoming extinct.

  10. Pattern of cerebrospinal immediate early gene c-fos expression in an ovine model of non-accidental head injury.

    PubMed

    Finnie, J W; Blumbergs, P C; Manavis, J; Vink, R

    2013-12-01

    Expression of the immediate early gene, c-fos, was examined in a large animal model of non-accidental head injury ("shaken baby syndrome"). Lambs were used because they have a relatively large gyrencephalic brain and weak neck muscles resembling a human infant. Neonatal lambs were manually shaken in a manner similar to that believed to occur with most abused human infants, but there was no head impact. The most striking c-fos expression was in meningothelial cells of the cranial cervical spinal cord and, to a lesser degree, in hemispheric, cerebellar, and brainstem meninges. Vascular endothelial cells also frequently showed c-fos immunopositivity in the meninges and hemispheric white matter. It was hypothesised that this c-fos immunoreactivity was due to mechanical stress induced by shaking, with differential movement of different craniospinal components. PMID:24035422

  11. Osteonecrosis of the jaws associated with use of risedronate: report of 2 new cases.

    PubMed

    Brooks, John K; Gilson, Allen J; Sindler, Arnold J; Ashman, Steven G; Schwartz, Kevin G; Nikitakis, Nikolaos G

    2007-06-01

    Use of various bisphosphonates has been associated with the development of osteonecrosis of the jaws (ONJ). At least 865 cases of ONJ attributed to these agents have been reported in the English-language literature. Approximately 96% of these published cases were seen with administration of the intravenous agents pamidronate and zoledronate, whereas only 26 cases have been associated with oral bisphosphonates, 25 of them with alendronate. Only a single case of ONJ associated with the oral bisphosphonate risedronate has been previously cited. We report 2 cases of ONJ attributed to risedronate administration. The patients developed osteonecrosis 15 and 24 months after treatment for osteopenia. A regimen of antibiotics and chlorhexidine mouthrinse resolved the osseous defect in the mandible caused by complete exfoliation of a lingual torus in 1 patient. The other patient required sequestrectomy, repeated courses of antibiotics, surgical debridement, and steroids to promote closure of an oroantral fistula and management of sinusitis after bone grafting and implant placement in the posterior maxilla. A demographic profile of reported oral bisphosphonate users affected by ONJ is also provided. With the millions of patients receiving various oral bisphosphonates for osteopenia and osteoporosis, health care practitioners should be aware of the potential for the onset of osteonecrosis and familiar with its management. PMID:17223592

  12. Bisphosphonate Associated Osteonecrosis of the Jaw: An Update on Pathophysiology, Risk Factors, and Treatment

    PubMed Central

    Rasmusson, Lars

    2014-01-01

    Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly. PMID:25254048

  13. Oral bisphosphonate-associated osteonecrosis of maxillary bone: A review of 18 cases

    PubMed Central

    Mardenlli, Fabiana; Paz, Marisa

    2014-01-01

    Biphosphonate-associated maxillary bone osteonecrosis (BPMO) is a complication related to nitrogen-containing biphosphonate therapy. This adverse effect occasionally appears in patients who are administered biphosphonates through intravenous infusion for the treatment of cancer involving bone metastases. It can also present, in a lesser degree, in patients who take these drugs orally for the treatment of osteoporosis. Lately, there has been an increase in the number of cases of osteopenia and osteoporosis due to the increasing life expectancy of the world’s population. In our country, a risk group composed mainly of older women who have been diagnosed with osteopenia or osteoporosis, and submitted to the continuous action of oral biphosphonates, is emerging. In this paper we present 18 cases of BPMO associated to the use of oral biphosphonates, diagnosed and treated in the Department of Stomatology of the School or Dentistry at Universidad Nacional de Rosario, Argentina. A protocol was designed in which the following information was recorded: age and sex of the patients, the original disease which led to therapy with oral biphosphonates, the drugs used and the period in which those drugs were administered, the clinical features and location of the lesions, together with triggering factors. Key words:Maxillary osteonecrosis, mandibular osteonecrosis, oral biphosphonates, alendronate, ibandronate. PMID:25674321

  14. Jaw osteonecrosis management around a dental implant inserted 2 years before starting treatment with zoledronic acid

    PubMed Central

    Marín-Fernández, Ana-Belén; García Medina, Blas; Aguilar-Salvatierra, Antonio; Jiménez-Burkhardt, Alberto

    2015-01-01

    Bisphosphonates (BP) are a type of drug known to inhibit bone resorption through complex interventions. Their primary mechanism of action is aimed at the cellular level, inhibiting osteoclast activity and so bone resorption. BPs are widely used, with many patients receiving continuous treatment for years. But it is well known that these drugs can produce osteonecrosis of the jaw (ONJ). Zoledronic acid (ZA) is an intravenous BP used in the treatment and prophylaxis of bone disease in patients with malignant tumors with bone implication. ZA is the most potent BP in clinical development. This report describes the case of a 62-year-old woman with breast cancer antecedents which relapsed, who had received a maxillary dental implant two years before the start of therapy with zoledronic acid. She later developed osteonecrosis of the jaw (ONJ), which began in the peri-implant area, and was treated for stage 3 ONJ by sub-total maxillectomy. Key words:Bisphosphonates, zoledronic acid, osteonecrosis of the jaw, peri-implantitis, maxillectomy. PMID:26330946

  15. Treatment of osteonecrosis of the jaw related to bisphosphonates and other antiresorptive agents

    PubMed Central

    Oñate-Sánchez, Ricardo-Elías

    2016-01-01

    Background The clinical management of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with bisphosphonates and other antiresorptive agents is subject to controversy. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has developed guidelines for the correct management of the disorder which are revised and updated by a panel of experts. Material and Methods The present systematic review analyzes the different treatments currently used to treat this clinical condition, based on the PRISMA® (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement published in 2009. An electronic Medline search was made of the PubMed database, covering the period 2006-2014. The last search date was 31 December 2014. Results A total of 29 articles were selected from the initial search according to the different drugs implicated in the appearance of osteonecrosis; the treatment modality used according to the stage of the disease; and the recorded success rate. Conclusions It is currently still recommended that the management of MRONJ should be decided according to the stage of the disease – conservative treatment being preferred in early stages without symptoms, while surgical management is preferred in the case of bone exposure with symptoms. Key words:Osteonecrosis, medication, bisphosphonates, treatments, review PMID:27475683

  16. Improving inferences from short-term ecological studies with Bayesian hierarchical modeling: white-headed woodpeckers in managed forests

    PubMed Central

    Linden, Daniel W; Roloff, Gary J

    2015-01-01

    Pilot studies are often used to design short-term research projects and long-term ecological monitoring programs, but data are sometimes discarded when they do not match the eventual survey design. Bayesian hierarchical modeling provides a convenient framework for integrating multiple data sources while explicitly separating sample variation into observation and ecological state processes. Such an approach can better estimate state uncertainty and improve inferences from short-term studies in dynamic systems. We used a dynamic multistate occupancy model to estimate the probabilities of occurrence and nesting for white-headed woodpeckers Picoides albolarvatus in recent harvest units within managed forests of northern California, USA. Our objectives were to examine how occupancy states and state transitions were related to forest management practices, and how the probabilities changed over time. Using Gibbs variable selection, we made inferences using multiple model structures and generated model-averaged estimates. Probabilities of white-headed woodpecker occurrence and nesting were high in 2009 and 2010, and the probability that nesting persisted at a site was positively related to the snag density in harvest units. Prior-year nesting resulted in higher probabilities of subsequent occurrence and nesting. We demonstrate the benefit of forest management practices that increase the density of retained snags in harvest units for providing white-headed woodpecker nesting habitat. While including an additional year of data from our pilot study did not drastically alter management recommendations, it changed the interpretation of the mechanism behind the observed dynamics. Bayesian hierarchical modeling has the potential to maximize the utility of studies based on small sample sizes while fully accounting for measurement error and both estimation and model uncertainty, thereby improving the ability of observational data to inform conservation and management strategies

  17. Improving inferences from short-term ecological studies with Bayesian hierarchical modeling: white-headed woodpeckers in managed forests.

    PubMed

    Linden, Daniel W; Roloff, Gary J

    2015-08-01

    Pilot studies are often used to design short-term research projects and long-term ecological monitoring programs, but data are sometimes discarded when they do not match the eventual survey design. Bayesian hierarchical modeling provides a convenient framework for integrating multiple data sources while explicitly separating sample variation into observation and ecological state processes. Such an approach can better estimate state uncertainty and improve inferences from short-term studies in dynamic systems. We used a dynamic multistate occupancy model to estimate the probabilities of occurrence and nesting for white-headed woodpeckers Picoides albolarvatus in recent harvest units within managed forests of northern California, USA. Our objectives were to examine how occupancy states and state transitions were related to forest management practices, and how the probabilities changed over time. Using Gibbs variable selection, we made inferences using multiple model structures and generated model-averaged estimates. Probabilities of white-headed woodpecker occurrence and nesting were high in 2009 and 2010, and the probability that nesting persisted at a site was positively related to the snag density in harvest units. Prior-year nesting resulted in higher probabilities of subsequent occurrence and nesting. We demonstrate the benefit of forest management practices that increase the density of retained snags in harvest units for providing white-headed woodpecker nesting habitat. While including an additional year of data from our pilot study did not drastically alter management recommendations, it changed the interpretation of the mechanism behind the observed dynamics. Bayesian hierarchical modeling has the potential to maximize the utility of studies based on small sample sizes while fully accounting for measurement error and both estimation and model uncertainty, thereby improving the ability of observational data to inform conservation and management strategies

  18. Modeling the effect of head drag reduction for a cylinder with a protruding disk at high mach numbers

    NASA Astrophysics Data System (ADS)

    Isaev, S. A.; Baranov, P. A.; Mikhalev, A. N.; Sudakov, A. G.

    2014-11-01

    Various approaches to modeling super- and hypersonic turbulent airflow past cylindrical bodies with a nontraditional nose in the form of a protruding rod-supported disk have been compared. Aeroballistic experiments on a light-gas propulsion setup were combined with wind tunnel tests and numerical simulations using VP2/3 program package based on multiblock computational techniques and a model of shear stress transport with flow-line curvature corrections. The phenomenon of the head and wave drag reduction for the stepped body is analyzed at high Mach numbers (up to 10) and variation of the supporting rod length under conditions of existence of the frontal flow separation zone.

  19. Theoretical and experimental investigation of near-infrared light propagation in a model of the adult head.

    PubMed

    Okada, E; Firbank, M; Schweiger, M; Arridge, S R; Cope, M; Delpy, D T

    1997-01-01

    Near-infrared light propagation in various models of the adult head is analyzed by both time-of-flight measurements and mathematical prediction. The models consist of three- or four-layered slabs, the latter incorporating a clear cerebrospinal fluid (CSF) layer. The most sophisticated model also incorporates slots that imitate sulci on the brain surface. For each model, the experimentally measured mean optical path length as a function of source-detector spacing agrees well with predictions from either a Monte Carlo model or a finite-element method based on diffusion theory or a hybrid radiosity-diffusion theory. Light propagation in the adult head is shown to be highly affected by the presence of the clear CSF layer, and both the optical path length and the spatial sensitivity profile of the models with a CSF layer are quite different from those without the CSF layer. However, the geometry of the sulci and the boundary between the gray and the white matter have little effect on the detected light distribution. PMID:18250644

  20. A three-dimensional virtual model of the head generated from digitalized CT or MR images for anatomical-radiological and neurosurgical evaluations.

    PubMed

    Juanes, J A; Espinel, J L; Velasco, M J; Zoreda, J L; Riesco, J M; Carmena, J J; Blanco, E; Marcos, J; Vazquez, R

    1996-12-01

    A computer-generated virtual model has been developed that reconstructs the head in three dimensions from digitalized images obtained with magnetic resonance and computerized tomography. Through programming and the use of commercial graphic animation software, we have developed the whole process of the rotation of the head on different spatial planes. The procedure permits multidirectional anatomical sections to be made on the structure of the head, providing a true dynamic and user-friendly anatomical-radiological atlas. The system serves as a virtual model for the localization of an ideal surgical approach to any lesion thus avoiding possible neurological lesions. PMID:9107107

  1. Head lice.

    PubMed

    Frankowski, Barbara L; Bocchini, Joseph A

    2010-08-01

    Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2002 clinical report on head lice was published by the American Academy of Pediatrics, patterns of resistance to products available over-the-counter and by prescription have changed, and additional mechanical means of removing head lice have been explored. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting. PMID:20660553

  2. Staging of osteonecrosis of the jaw requires computed tomography for accurate definition of the extent of bony disease.

    PubMed

    Bedogni, Alberto; Fedele, Stefano; Bedogni, Giorgio; Scoletta, Matteo; Favia, Gianfranco; Colella, Giuseppe; Agrillo, Alessandro; Bettini, Giordana; Di Fede, Olga; Oteri, Giacomo; Fusco, Vittorio; Gabriele, Mario; Ottolenghi, Livia; Valsecchi, Stefano; Porter, Stephen; Petruzzi, Massimo; Arduino, Paolo; D'Amato, Salvatore; Ungari, Claudio; Fung Polly, Pok-Lam; Saia, Giorgia; Campisi, Giuseppina

    2014-09-01

    Management of osteonecrosis of the jaw associated with antiresorptive agents is challenging, and outcomes are unpredictable. The severity of disease is the main guide to management, and can help to predict prognosis. Most available staging systems for osteonecrosis, including the widely-used American Association of Oral and Maxillofacial Surgeons (AAOMS) system, classify severity on the basis of clinical and radiographic findings. However, clinical inspection and radiography are limited in their ability to identify the extent of necrotic bone disease compared with computed tomography (CT). We have organised a large multicentre retrospective study (known as MISSION) to investigate the agreement between the AAOMS staging system and the extent of osteonecrosis of the jaw (focal compared with diffuse involvement of bone) as detected on CT. We studied 799 patients with detailed clinical phenotyping who had CT images taken. Features of diffuse bone disease were identified on CT within all AAOMS stages (20%, 8%, 48%, and 24% of patients in stages 0, 1, 2, and 3, respectively). Of the patients classified as stage 0, 110/192 (57%) had diffuse disease on CT, and about 1 in 3 with CT evidence of diffuse bone disease was misclassified by the AAOMS system as having stages 0 and 1 osteonecrosis. In addition, more than a third of patients with AAOMS stage 2 (142/405, 35%) had focal bone disease on CT. We conclude that the AAOMS staging system does not correctly identify the extent of bony disease in patients with osteonecrosis of the jaw. PMID:24856927

  3. Impact of Actinomyces naeslundii on bisphosphonate-related osteonecrosis of the jaws in ovariectomized rats with periodontitis.

    PubMed

    Li, Chun Lei; Seneviratne, Chaminda Jayampath; Huo, Lei; Lu, Weijia William; Zheng, Li Wu

    2015-10-01

    Bisphosphonates-related osteonecrosis of the jaws (BRONJ) is a severe complication of BPs therapy with unknown pathogenesis. This study aimed to evaluate the impact of Actinomyces naeslundii (A. naeslundii) on the progression of BRONJ in ovariectomized (OVX) rat model with periodontal diseases. Sixty rats were randomly assigned into four groups. All rats underwent bilateral ovariectomy. Six weeks after surgery, animals with periodontitis induced by ligature placement were administrated with normal saline (NS), NS &A. naeslundii inoculation, zolecdronic acid (ZA) and ZA &A. naeslundii inoculation for 12 weeks, respectively. Loads of total bacteria and A. naeslundii in the mouth were assessed by real time PCR. After sacrifice, the mandibles were harvested for micro-computed tomography (micro-CT) and histological examination. Real-time PCR demonstrated that A. naeslundii was not routinely found in the rats and ZA treatment did not promote its accumulation. Micro-CT examination disclosed that ligature placement induced significant alveolar bone loss, which was greatly attenuated by ZA treatment and aggravated by A. naeslundii. Histological assessment demonstrated that ZA treatment increased the risk of developing BRONJ-like disease but this condition was not worsen with the presence of A. naeslundii. Our study suggested that oral A. naeslundii inoculation aggravated periodontal disease but not BRONJ in our animal model. PMID:26293192

  4. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture

    PubMed Central

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-01-01

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. PMID:25015169

  5. Impact of head models in N170 component source imaging: results in control subjects and ADHD patients

    NASA Astrophysics Data System (ADS)

    Beltrachini, L.; Blenkmann, A.; von Ellenrieder, N.; Petroni, A.; Urquina, H.; Manes, F.; Ibáñez, A.; Muravchik, C. H.

    2011-12-01

    The major goal of evoked related potential studies arise in source localization techniques to identify the loci of neural activity that give rise to a particular voltage distribution measured on the surface of the scalp. In this paper we evaluate the effect of the head model adopted in order to estimate the N170 component source in attention deficit hyperactivity disorder (ADHD) patients and control subjects, considering faces and words stimuli. The standardized low resolution brain electromagnetic tomography algorithm (sLORETA) is used to compare between the three shell spherical head model and a fully realistic model based on the ICBM-152 atlas. We compare their variance on source estimation and analyze the impact on the N170 source localization. Results show that the often used three shell spherical model may lead to erroneous solutions, specially on ADHD patients, so its use is not recommended. Our results also suggest that N170 sources are mainly located in the right occipital fusiform gyrus for faces stimuli and in the left occipital fusiform gyrus for words stimuli, for both control subjects and ADHD patients. We also found a notable decrease on the N170 estimated source amplitude on ADHD patients, resulting in a plausible marker of the disease.

  6. Modeling distance-dependent individual head-related transfer functions in the horizontal plane using frontal projection headphones.

    PubMed

    Sunder, Kaushik; Gan, Woon-Seng; Tan, Ee-Leng

    2015-07-01

    The veracity of virtual audio is degraded by the use of non-individualized head-related transfer functions (HRTFs) due to the introduction of front-back, elevation confusions, and timbral coloration. Hence, an accurate reproduction of spatial sound demands the use of individualized HRTFs. Measuring distance-dependent individualized HRTFs can be extremely tedious, since it requires precise measurements at several distances in the proximal region (<1 m) for each individual. This paper proposes a technique to model distance-dependent individualized HRTFs in the horizontal plane using "frontal projection headphones playback" that does not require individualized measurements. The frontal projection headphones [Sunder, Tan, and Gan (2013). J. Audio Eng. Soc. 61, 989-1000] project the sound directly onto the pinnae from the front, and thus inherently create listener's idiosyncratic pinna cues at the eardrum. Perceptual experiments were conducted to investigate cues (auditory parallax and interaural level differences) that aid distance perception in anechoic conditions. Interaural level differences were identified as the prominent cue for distance perception and a spherical head model was used to model these distance-dependent features. Detailed psychophysical experiments revealed that the modeled distance-dependent individualized HRTFs exhibited localization performance close to the measured distance-dependent individualized HRTFs for all subjects. PMID:26233016

  7. Dynamics of the head-neck complex in response to the trunk horizontal vibration: modeling and identification.

    PubMed

    Fard, Mohammad A; Ishihara, Tadashi; Inooka, Hikaru

    2003-08-01

    Although many studies exist concerning the influence of seat vibration on the head in the seated human body, the dynamic response of the head-neck complex (HNC) to the trunk vibration has not been well investigated. Little quantitative knowledge exists about viscoelastic parameters of the neck. In this study, the dynamics of the HNC is identified when it is exposed to the trunk horizontal (fore-and-aft) vibration. The frequency response functions between the HNC angular velocity and the trunk horizontal acceleration, corresponding to four volunteers, are obtained in the frequency range of 0.5 Hz to 10 Hz. A fourth-order mathematical model, derived by considering a double-inverted-pendulum model for the HNC, is designed to simulate the dynamic response of the HNC to the trunk horizontal vibration. The frequency domain identification method is used to determine the coefficients of the mathematical model of the HNC. Good agreement has been obtained between experimental and simulation results. This indicates that the system, similar to the designed fourth-order model, has mainly two resonance frequencies. The viscoelastic parameters of the neck, including the spring and damping coefficients, are then obtained by use of the optimization method. PMID:12968578

  8. The role of cerebral spinal fluid in light propagation through the mouse head: improving fluorescence tomography with Monte Carlo modeling

    NASA Astrophysics Data System (ADS)

    Ancora, Daniele; Zacharopoulos, Athanasios; Ripoll, Jorge; Zacharakis, Giannis

    2016-03-01

    Optical Neuroimaging is a highly dynamical field of research owing to the combination of many advanced imaging techniques and computational tools that uncovered unexplored paths through the functioning of the brain. Light propagation modelling through such complicated structures has always played a crucial role as the basis for a high resolution and quantitative imaging where even the slightest improvement could lead to significant results. Fluorescence Diffuse Optical Tomography (fDOT), a widely used technique for three dimensional imaging of small animals and tissues, has been proved to be inaccurate for neuroimaging the mouse head without the knowledge of a-priori anatomical information of the subject. Commonly a normalized Born approximation model is used in fDOT reconstruction based on forward photon propagation using Diffusive Equation (DE) which has strong limitations in the optically clear regime. The presence of the Cerebral Spinal Fluid (CSF) instead, a thin optically clear layer surrounding the brain, can be more accurately taken into account using Monte Carlo approaches which nowadays is becoming more usable thanks to parallelized GPU algorithms. In this work we discuss the results of a synthetic experimental comparison, resulting to the increase of the accuracy for the Born approximation by introducing the CSF layer in a realistic mouse head structure with respect to the current model. We point out the importance of such clear layer for complex geometrical models, while for simple slab phantoms neglecting it does not introduce a significant error.

  9. SU-E-T-08: A Convolution Model for Head Scatter Fluence in the Intensity Modulated Field

    SciTech Connect

    Chen, M; Mo, X; Chen, Y; Parnell, D; Key, S; Olivera, G; Galmarini, W; Lu, W

    2014-06-01

    Purpose: To efficiently calculate the head scatter fluence for an arbitrary intensity-modulated field with any source distribution using the source occlusion model. Method: The source occlusion model with focal and extra focal radiation (Jaffray et al, 1993) can be used to account for LINAC head scatter. In the model, the fluence map of any field shape at any point can be calculated via integration of the source distribution within the visible range, as confined by each segment, using the detector eye's view. A 2D integration would be required for each segment and each fluence plane point, which is time-consuming, as an intensity-modulated field contains typically tens to hundreds of segments. In this work, we prove that the superposition of the segmental integrations is equivalent to a simple convolution regardless of what the source distribution is. In fact, for each point, the detector eye's view of the field shape can be represented as a function with the origin defined at the point's pinhole reflection through the center of the collimator plane. We were thus able to reduce hundreds of source plane integration to one convolution. We calculated the fluence map for various 3D and IMRT beams and various extra-focal source distributions using both the segmental integration approach and the convolution approach and compared the computation time and fluence map results of both approaches. Results: The fluence maps calculated using the convolution approach were the same as those calculated using the segmental approach, except for rounding errors (<0.1%). While it took considerably longer time to calculate all segmental integrations, the fluence map calculation using the convolution approach took only ∼1/3 of the time for typical IMRT fields with ∼100 segments. Conclusions: The convolution approach for head scatter fluence calculation is fast and accurate and can be used to enhance the online process.

  10. Magnetic fabric and modeled strain distribution in the head of a nested granite diapir, the Melechov pluton, Bohemian Massif

    NASA Astrophysics Data System (ADS)

    Trubač, Jakub; Žák, Jiří; Chlupáčová, Marta; Janoušek, Vojtěch

    2014-09-01

    The Melechov pluton, Bohemian Massif, is interpreted as a mid-crustal nested granitic diapir with an apical part exposed at the present-day erosion level. The diapir head exhibits a concentric structure defined by lithologic zoning and by the anisotropy of magnetic susceptibility (AMS). In concert with theoretical models, outward-dipping margin-parallel magnetic foliations are associated with oblate shapes of the susceptibility ellipsoids and higher degree of anisotropy, passing inward into weaker triaxial to prolate fabric. By contrast, magnetic fabric in an inner granite unit is in places oriented at a high angle to internal contacts and is interpreted as recording an internal diapir circulation. We use inverse modeling to calculate strain variations across the diapir from the AMS data. The magnetic fabric parameters and calculated strains are in agreement with strain distribution in heads of model Newtonian diapirs traveling a distance of two body radii and suggest granitic magma ascent as a crystal-poor suspension followed by crystallization of fabric markers and their response to strain near the final emplacement level. The intrusive fabric thus formed late but, though generally weak, was still capable of recording incremental strain gradient in the granite diapir.

  11. Temporal and Spatial Weighting of Head and Concentration Observations for a Large-Scale Transient Inverse Model

    SciTech Connect

    Scheibe, Timothy D.; Murray, Christopher J.; Xie, YuLong; Williams, Mark D.; Cole, Charles R.; Vermeul, Vince R.; Bergeron, Marcel P.

    2003-09-19

    A regional-scale, three-dimensional groundwater flow and transport modeling effort is ongoing to quantify the environmental consequences of past waste disposal activities and support environmental management activities at the U.S. Department of Energy’s 560-square-mile Hanford Site in southeastern Washington. On the order of one thousand wells in the deep surficial aquifer have been monitored over several decades of site operations (beginning in the 1940’s), and tens of thousands of observations of water table elevation (head) and contaminant concentrations (primarily tritium) have been made over that same period. These data are currently being used as the basis for a site-wide inverse modeling effort to identify model parameters and quantify model uncertainty. Several issues complicate the assignment of appropriate weights to the observations used in the inverse modeling process. The precision of available monitoring techniques has changed significantly over the modeled time period, and the associated error weighting should reflect the methods used (which were in some cases not well documented). In some cases, the detection limits are poorly defined, and some analytical techniques can give rise to non-physical results (such as negative measured concentrations). In addition, the data are strongly clustered both in space and time. This presents the possibility of the inverse solution being too strongly influenced by a cluster of similar values. However, the elimination of some data by declustering techniques, or alternatively, the adjustment of observation weights used in the objective function, raises problems with interpretation and regulatory acceptance of model predictions and uncertainty estimates. This paper presents the methods we have utilized to assign appropriate weights to head and concentration observations and discusses potential issues associated with the weighting scheme employed.

  12. Structure-based modeling of head-related transfer functions towards interactive customization of binaural sound systems

    NASA Astrophysics Data System (ADS)

    Gupta, Navarun

    2003-10-01

    One of the most popular techniques for creating spatialized virtual sounds is based on the use of Head-Related Transfer Functions (HRTFs). HRTFs are signal processing models that represent the modifications undergone by the acoustic signal as it travels from a sound source to each of the listener's eardrums. These modifications are due to the interaction of the acoustic waves with the listener's torso, shoulders, head and pinnae, or outer ears. As such, HRTFs are somewhat different for each listener. For a listener to perceive synthesized 3-D sound cues correctly, the synthesized cues must be similar to the listener's own HRTFs. One can measure individual HRTFs using specialized recording systems, however, these systems are prohibitively expensive and restrict the portability of the 3-D sound system. HRTF-based systems also face several computational challenges. This dissertation presents an alternative method for the synthesis of binaural spatialized sounds. The sound entering the pinna undergoes several reflective, diffractive and resonant phenomena, which determine the HRTF. Using signal processing tools, such as Prony's signal modeling method, an appropriate set of time delays and a resonant frequency were used to approximate the measured Head-Related Impulse Responses (HRIRs). Statistical analysis was used to find out empirical equations describing how the reflections and resonances are determined by the shape and size of the pinna features obtained from 3D images of 15 experimental subjects modeled in the project. These equations were used to yield "Model HRTFs" that can create elevation effects. Listening tests conducted on 10 subjects show that these model HRTFs are 5% more effective than generic HRTFs when it comes to localizing sounds in the frontal plane. The number of reversals (perception of sound source above the horizontal plane when actually it is below the plane and vice versa) was also reduced by 5.7%, showing the perceptual effectiveness of this

  13. A Novel Closed-Head Model of Mild Traumatic Brain Injury Using Focal Primary Overpressure Blast to the Cranium in Mice.

    PubMed

    Guley, Natalie H; Rogers, Joshua T; Del Mar, Nobel A; Deng, Yunping; Islam, Rafiqul M; D'Surney, Lauren; Ferrell, Jessica; Deng, Bowei; Hines-Beard, Jessica; Bu, Wei; Ren, Huiling; Elberger, Andrea J; Marchetta, Jeffrey G; Rex, Tonia S; Honig, Marcia G; Reiner, Anton

    2016-02-15

    Mild traumatic brain injury (TBI) from focal head impact is the most common form of TBI in humans. Animal models, however, typically use direct impact to the exposed dura or skull, or blast to the entire head. We present a detailed characterization of a novel overpressure blast system to create focal closed-head mild TBI in mice. A high-pressure air pulse limited to a 7.5 mm diameter area on the left side of the head overlying the forebrain is delivered to anesthetized mice. The mouse eyes and ears are shielded, and its head and body are cushioned to minimize movement. This approach creates mild TBI by a pressure wave that acts on the brain, with minimal accompanying head acceleration-deceleration. A single 20-psi blast yields no functional deficits or brain injury, while a single 25-40 psi blast yields only slight motor deficits and brain damage. By contrast, a single 50-60 psi blast produces significant visual, motor, and neuropsychiatric impairments and axonal damage and microglial activation in major fiber tracts, but no contusive brain injury. This model thus reproduces the widespread axonal injury and functional impairments characteristic of closed-head mild TBI, without the complications of systemic or ocular blast effects or head acceleration that typically occur in other blast or impact models of closed-skull mild TBI. Accordingly, our model provides a simple way to examine the biomechanics, pathophysiology, and functional deficits that result from TBI and can serve as a reliable platform for testing therapies that reduce brain pathology and deficits. PMID:26414413

  14. Mandibular osteonecrosis following herpes zoster infection in the mandibular branch of the trigeminal nerve: a case report and literature review

    PubMed Central

    2015-01-01

    Herpes zoster virus (HZV) infections are caused by reactivation of the varicella zoster virus. Reactivation symptoms commonly affect the thoracolumbar trunk, and rarely affect the mandibular branches of the trigeminal nerve. When the mandibular branches are involved, lesions appear proximal to the innervation area. This condition may be associated with exfoliation of the teeth and osteonecrosis of the jawbone. We report a case of mandibular osteomyelitis after herpes zoster infection and we present a review of the literature on mandibular-branch involvement of HZV-related osteonecrosis. PMID:26733193

  15. Integrating deterministic lithostratigraphic models in stochastic realizations of subsurface heterogeneity. Impact on predictions of lithology, hydraulic heads and groundwater fluxes

    NASA Astrophysics Data System (ADS)

    Bianchi, Marco; Kearsey, Timothy; Kingdon, Andrew

    2015-12-01

    Realistic representations of geological complexity are important to address several engineering and environmental challenges. The spatial distribution of properties controlling physical and geochemical processes can be effectively described by the geological structure of the subsurface. In this work, we present an approach to account for geological structure in geostatistical simulations of categorical variables. The approach is based on the extraction of information from a deterministic conceptualization of the subsurface, which is then used in the geostatistical analysis for the development of models of spatial correlation and as soft conditioning data. The approach was tested to simulate the distribution of four lithofacies in highly heterolithic Quaternary deposits. A transition probability-based stochastic model was implemented using hard borehole data and soft data extracted from a 3-D deterministic lithostratigraphic model. Simulated lithofacies distributions were also used as input in a flow model for numerical simulation of hydraulic head and groundwater flux. The outputs from these models were compared to corresponding values from models based exclusively on borehole data. Results show that soft lithostratigraphic information increases the accuracy and reduces the uncertainty of these predictions. The representation of the geological structure also allows a more precise definition of the spatial distribution of prediction uncertainty, here quantified with a metric based on Shannon information entropy. Correlations between prediction uncertainties for lithofacies, hydraulic heads and groundwater fluxes were also investigated. The results from this analysis provide useful insights about the incorporation of soft geological data into stochastic realizations of subsurface heterogeneity, and emphasize the critical importance of this type of information for reducing the uncertainty of simulations considering flux-dependent processes.

  16. Normal Tissue Complication Probability Modeling of Radiation-Induced Hypothyroidism After Head-and-Neck Radiation Therapy

    SciTech Connect

    Bakhshandeh, Mohsen; Hashemi, Bijan; Mahdavi, Seied Rabi Mehdi; Nikoofar, Alireza; Vasheghani, Maryam; Kazemnejad, Anoshirvan

    2013-02-01

    Purpose: To determine the dose-response relationship of the thyroid for radiation-induced hypothyroidism in head-and-neck radiation therapy, according to 6 normal tissue complication probability models, and to find the best-fit parameters of the models. Methods and Materials: Sixty-five patients treated with primary or postoperative radiation therapy for various cancers in the head-and-neck region were prospectively evaluated. Patient serum samples (tri-iodothyronine, thyroxine, thyroid-stimulating hormone [TSH], free tri-iodothyronine, and free thyroxine) were measured before and at regular time intervals until 1 year after the completion of radiation therapy. Dose-volume histograms (DVHs) of the patients' thyroid gland were derived from their computed tomography (CT)-based treatment planning data. Hypothyroidism was defined as increased TSH (subclinical hypothyroidism) or increased TSH in combination with decreased free thyroxine and thyroxine (clinical hypothyroidism). Thyroid DVHs were converted to 2 Gy/fraction equivalent doses using the linear-quadratic formula with {alpha}/{beta} = 3 Gy. The evaluated models included the following: Lyman with the DVH reduced to the equivalent uniform dose (EUD), known as LEUD; Logit-EUD; mean dose; relative seriality; individual critical volume; and population critical volume models. The parameters of the models were obtained by fitting the patients' data using a maximum likelihood analysis method. The goodness of fit of the models was determined by the 2-sample Kolmogorov-Smirnov test. Ranking of the models was made according to Akaike's information criterion. Results: Twenty-nine patients (44.6%) experienced hypothyroidism. None of the models was rejected according to the evaluation of the goodness of fit. The mean dose model was ranked as the best model on the basis of its Akaike's information criterion value. The D{sub 50} estimated from the models was approximately 44 Gy. Conclusions: The implemented normal tissue

  17. Head injury.

    PubMed

    Hureibi, K A; McLatchie, G R

    2010-05-01

    Head injury is one of the commonest injuries in sport. Most are mild but some can have serious outcomes. Sports medicine doctors should be able to recognise the clinical features and evaluate athletes with head injury. It is necessary during field assessment to recognise signs and symptoms that help in assessing the severity of injury and making a decision to return-to-play. Prevention of primary head injury should be the aim. This includes protective equipment like helmets and possible rule changes. PMID:20533694

  18. Blunt force impact to the head using a teeball bat: systematic comparison of physical and finite element modeling.

    PubMed

    Kettner, Mattias; Ramsthaler, Frank; Potente, Stefan; Bockenheimer, Alexander; Schmidt, Peter H; Schrodt, Michael

    2014-12-01

    Blunt head trauma secondary to violent actions with various weapons is frequently a cause of injury in forensic casework; differing striking tools have varying degrees of injury capacity. The systematic approach used to examine a 19-year-old student who was beaten with a wooden teeball bat will be described. The assailant stopped beating the student when the teeball bat broke into two pieces. The surviving victim sustained bruises and a forehead laceration. The State's Attorney assigned a forensic expert to examine whether the forces exerted on the victim's head (leading to the fracture of the bat) were potentially life threatening (e.g. causing cranial bone fractures). Physical modeling was conducted using a pigskin-covered polyethylene end cap cushioned by cellulose that was connected to a piezoelectric force gauge. Experiments with teeball bats weighing 295-485 g demonstrated that 12-20 kN forces were necessary to cause a comparable bat fracture. In addition to physical testing, a computer-aided simulation was conducted, utilizing a finite-element (FE) method. In the FE approach, after selecting for wood properties, a virtual bat was swung against a hemisphere comprising two layers that represented bone and soft tissue. Employing this model, a 17.6 kN force was calculated, with the highest fracture probability points resembling the fracture patterns of the physically tested bats. PMID:25107575

  19. Depth-compensated diffuse optical tomography enhanced by general linear model analysis and an anatomical atlas of human head.

    PubMed

    Tian, Fenghua; Liu, Hanli

    2014-01-15

    One of the main challenges in functional diffuse optical tomography (DOT) is to accurately recover the depth of brain activation, which is even more essential when differentiating true brain signals from task-evoked artifacts in the scalp. Recently, we developed a depth-compensated algorithm (DCA) to minimize the depth localization error in DOT. However, the semi-infinite model that was used in DCA deviated significantly from the realistic human head anatomy. In the present work, we incorporated depth-compensated DOT (DC-DOT) with a standard anatomical atlas of human head. Computer simulations and human measurements of sensorimotor activation were conducted to examine and prove the depth specificity and quantification accuracy of brain atlas-based DC-DOT. In addition, node-wise statistical analysis based on the general linear model (GLM) was also implemented and performed in this study, showing the robustness of DC-DOT that can accurately identify brain activation at the correct depth for functional brain imaging, even when co-existing with superficial artifacts. PMID:23859922

  20. On the magnetic field distribution generated by a dipolar current source situated in a realistically shaped compartment model of the head.

    PubMed

    Meijs, J W; Bosch, F G; Peters, M J; Lopes da Silva, F H

    1987-03-01

    The magnetic field distribution around the head is simulated using a realistically shaped compartment model of the head. The model is based on magnetic resonance images. The 3 compartments describe the brain, the skull and the scalp. The source is represented by a current dipole situated in the visual cortex. The magnetic field distribution due to the source and that due to the volume currents are calculated separately. The simulations are carried out in order to ascertain which matrix of grid points is suitable as a measuring grid. The possibilities studied are grid points situated in a plane, in a surface which follows the co