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Cardín-Pereda A, García-Sánchez D, Terán-Villagrá N, Alfonso-Fernández A, Fakkas M, Pérez-Del Barrio A, Marín-Díez E, Fernández-Lobo V, Sanz-Bellón P, Montes-Figueroa E, Lamprecht Y, Pérez-Campo FM. Diagnostic Reliability of Plain Radiography in Osteonecrosis of the Femoral Head: General Radiological Features Revised. Curr Med Imaging 2023; 20:CMIR-EPUB-134130. [PMID: 37649291 DOI: 10.2174/1573405620666230829150229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Osteonecrosis of the femoral head (ONFH) is an incapacitating disease that frequently results in the collapse of the femoral head and secondary osteoarthritis. The diagnosis and staging of this pathology, which usually rely on imaging studies, are challenging. Currently, conventional radiography is the basis of the initial diagnostic assessment. In recent decades, however, radiographs have been considered insensitive to early changes in ONFH and thus, a suboptimal diagnostic tool. Paradoxically, the imaging features of radiographs are often profuse, substantial, and characteristic. This study aimed to elucidate the real limitations of this radiologic tool by assessing the diagnostic reliability of the key radiologic features and staging. METHODS This was a retrospective study in which radiographs from 28 idiopathic ONFH confirmed cases who underwent hip arthroplasty were analyzed by eight observers who were asked to identify the presence or absence of ONFH universally reported imaging features in AP hip radiographs. RESULTS Concordance analysis revealed a poor agreement between observers for most of the assessed imaging features. Only the identification of femoral head flattening and osteoarthritis signs exhibited moderate agreement with statistical significance. In contrast, the detection of radiological osteoporosis and the loss of trabeculation showed the lowest reliability, with negative kappa coefficients. CONCLUSION There is a lack of agreement between qualified observers, even for the identification of the most characteristic ONFH radiographic feature. The reliability of plain radiography for the detection of basic radiological elements is even weaker in the early stages of the disease.
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Affiliation(s)
- Adrian Cardín-Pereda
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL, 39012, Santander, Spain
| | - Daniel García-Sánchez
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL, 39012, Santander, Spain
| | - Nuria Terán-Villagrá
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008, Santander, Spain
| | - Ana Alfonso-Fernández
- University of Cantabria Servicio de Traumatología y Ortopedia, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria Santander Spain
| | - Michel Fakkas
- Marqués de Valdecilla University Hospital Servicio de Traumatología y Ortopedia, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria Santander Spain
| | - Amaia Pérez-Del Barrio
- Clinica Universidad de Navarra Servicio de Radiología (Sección de Radiología Musculoesquelética), Hospital Universitario de Navarra Pamplona Spain
| | - Elena Marín-Díez
- Marqués de Valdecilla University Hospital Radiology Santander Spain
| | | | | | | | - Yasmina Lamprecht
- Charité - University Medicine Berlin Klinik für Radiologie Berlin Germany
| | - Flor María Pérez-Campo
- University of Cantabria Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL Santander Spain
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García-Sánchez D, González-González A, Alfonso-Fernández A, Del Dujo-Gutiérrez M, Pérez-Campo FM. Communication between bone marrow mesenchymal stem cells and multiple myeloma cells: Impact on disease progression. World J Stem Cells 2023; 15:421-437. [PMID: 37342223 PMCID: PMC10277973 DOI: 10.4252/wjsc.v15.i5.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/27/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy characterized by the accumulation of immunoglobulin-secreting clonal plasma cells at the bone marrow (BM). The interaction between MM cells and the BM microenvironment, and specifically BM mesenchymal stem cells (BM-MSCs), has a key role in the pathophysiology of this disease. Multiple data support the idea that BM-MSCs not only enhance the proliferation and survival of MM cells but are also involved in the resistance of MM cells to certain drugs, aiding the progression of this hematological tumor. The relation of MM cells with the resident BM-MSCs is a two-way interaction. MM modulate the behavior of BM-MSCs altering their expression profile, proliferation rate, osteogenic potential, and expression of senescence markers. In turn, modified BM-MSCs can produce a set of cytokines that would modulate the BM microenvironment to favor disease progression. The interaction between MM cells and BM-MSCs can be mediated by the secretion of a variety of soluble factors and extracellular vesicles carrying microRNAs, long non-coding RNAs or other molecules. However, the communication between these two types of cells could also involve a direct physical interaction through adhesion molecules or tunneling nanotubes. Thus, understanding the way this communication works and developing strategies to interfere in the process, would preclude the expansion of the MM cells and might offer alternative treatments for this incurable disease.
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Affiliation(s)
- Daniel García-Sánchez
- Department of Molecular Biology_IDIVAL, Faculty of Medicine, University of Cantabria, Santander 39011, Cantabria, Spain
| | - Alberto González-González
- Department of Molecular Biology_IDIVAL, Faculty of Medicine, University of Cantabria, Santander 39011, Cantabria, Spain
| | - Ana Alfonso-Fernández
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Facultad de Medicina, Universidad de Cantabria, Santander 39008, Cantabria, Spain
| | - Mónica Del Dujo-Gutiérrez
- Department of Molecular Biology_IDIVAL, Faculty of Medicine, University of Cantabria, Santander 39011, Cantabria, Spain
| | - Flor M Pérez-Campo
- Department of Molecular Biology_IDIVAL, Faculty of Medicine, University of Cantabria, Santander 39011, Cantabria, Spain
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Cardín-Pereda A, García-Sánchez D, Terán-Villagrá N, Alfonso-Fernández A, Fakkas M, Garcés-Zarzalejo C, Pérez-Campo FM. Osteonecrosis of the Femoral Head: A Multidisciplinary Approach in Diagnostic Accuracy. Diagnostics (Basel) 2022; 12:diagnostics12071731. [PMID: 35885636 PMCID: PMC9324583 DOI: 10.3390/diagnostics12071731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Osteonecrosis of the Femoral Head (ONFH) is a disabling disease affecting up to 30,000 people yearly in the United States alone. Diagnosis and staging of this pathology are both technically and logistically challenging, usually relying on imaging studies. Even anatomopathological studies, considered the gold standard for identifying ONFH, are not exempt from problems. In addition, the diagnosis is often made by different healthcare specialists, including orthopedic surgeons and radiologists, using different imaging modes, macroscopic features, and stages. Therefore, it is not infrequent to find disagreements between different specialists. The aim of this paper is to clarify the association and accuracy of ONFH diagnosis between healthcare professionals. To this end, femoral head specimens from patients with a diagnosis of ONFH were collected from patients undergoing hip replacement surgery. These samples were later histologically analyzed to establish an ONFH diagnosis. We found that clinico-radiological diagnosis of ONFH evidences a high degree of histological confirmation, thus showing an acceptable diagnostic accuracy. However, when the diagnoses of radiologists and orthopedic surgeons are compared with each other, there is only a moderate agreement. Our results underscore the need to develop an effective diagnosis based on a multidisciplinary approach to enhance currently limited accuracy and reliability.
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Affiliation(s)
- Adrián Cardín-Pereda
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL, 39012 Santander, Spain;
- Correspondence: (A.C.-P.); (F.M.P.-C.); Tel.: +34-942200958 (F.M.P.-C.)
| | - Daniel García-Sánchez
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL, 39012 Santander, Spain;
| | - Nuria Terán-Villagrá
- Servicio de Anatomía Patológica, Hospital UM Valdecilla, Universidad de Cantabria, 39008 Santander, Spain;
| | - Ana Alfonso-Fernández
- Servicio de Traumatología y Ortopedia, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, 39008 Santander, Spain; (A.A.-F.); (M.F.); (C.G.-Z.)
| | - Michel Fakkas
- Servicio de Traumatología y Ortopedia, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, 39008 Santander, Spain; (A.A.-F.); (M.F.); (C.G.-Z.)
| | - Carlos Garcés-Zarzalejo
- Servicio de Traumatología y Ortopedia, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, 39008 Santander, Spain; (A.A.-F.); (M.F.); (C.G.-Z.)
| | - Flor María Pérez-Campo
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL, 39012 Santander, Spain;
- Correspondence: (A.C.-P.); (F.M.P.-C.); Tel.: +34-942200958 (F.M.P.-C.)
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Hernández-Elena J, de la Red-Gallego M, Garcés-Zarzalejo C, Pascual-Carra M, Pérez-Aguilar M, Rodríguez-López T, Alfonso-Fernández A, Pérez-Núñez M. Treatment of proximal humeral fractures by reverse shoulder arthroplasty: Mid-term evaluation of functional results and Notching. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hernández-Elena J, de la Red-Gallego MÁ, Garcés-Zarzalejo C, Pascual-Carra MA, Pérez-Aguilar MD, Rodríguez-López T, Alfonso-Fernández A, Pérez-Núñez MI. [Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:413-20. [PMID: 26165592 DOI: 10.1016/j.recot.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/27/2015] [Accepted: 05/01/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. METHODS A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. RESULTS Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. CONCLUSION Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching.
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Affiliation(s)
- J Hernández-Elena
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Traumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - M Á de la Red-Gallego
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Traumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - C Garcés-Zarzalejo
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Traumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - M A Pascual-Carra
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Traumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - M D Pérez-Aguilar
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Traumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - T Rodríguez-López
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Traumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - A Alfonso-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - M I Pérez-Núñez
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Traumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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