Objective: To propose a new definition of the pericollapse stage of osteonecrosis of the femoral head (ONFH) and review its significance in disease diagnosis and treatment selection. Data Sources: A search for eligible studies was conducted in three electronic databases including PubMed, Cochrane Library, and Embase up to August 10, 2018, using the following keywords: “osteonecrosis”, “prognosis”, and “treatment”. Study Selection: Investigations appraising the clinical signs, symptoms, and imaging manifestations in different stages of ONFH were included. Articles evaluating the prognosis of various joint-preserving procedures were also reviewed. Results: The pericollapse stage refers to a continuous period in the development of ONFH from the occurrence of subchondral fracture to early collapse (<2 mm), possessing specific imaging features that mainly consist of bone marrow edema and joint effusion on magnetic resonance imaging (MRI), crescent signs on X-ray films, and clinical manifestations such as the sudden worsening of hip pain. Accumulating evidence has indicated that these findings may be secondary to the changes after subchondral fractures. Of note, computed tomography provides more information for identifying possible subchondral fractures than does MRI and serves as the most sensitive tool for grading the pericollapse lesion stage. The pericollapse stage may indicate a high possibility of progressive disease but also demonstrates satisfactory long- and medium-term outcomes for joint-preserving techniques. In fact, if the articular surface subsides more than 2 mm, total hip arthroplasty is preferable. Conclusions: The pericollapse stage with distinct clinical and imaging characteristics provides a last good opportunity for the use of joint-preserving techniques. It is necessary to separate the pericollapse stage as an independent state in evaluating the natural progression of ONFH and selecting an appropriate treatment regimen. 股骨头坏死的围塌陷期：保髋治疗的最后良机 摘要 目的：本文提出了股骨头坏死围塌陷期的最新定义并回顾了其在疾病诊断和治疗方案选择中的意义。 数据来源：通过使用“骨坏死”、“预后”和“治疗”三个关键词，我们对包括PubMed，Cochrane图书馆和Embase（截止到2018年8月10日）在内的三个数据库进行了系统的检索，寻找合适的文献。 研究选择：纳入评价股骨头坏死不同时期的临床症状、体征和影像学表现的研究。评估不同保髋治疗预后的文章也纳入了本系统回顾。 结果：围塌陷期指的是从软骨下骨骨折到轻微塌陷（小于2mm）出现这之间的一段连续时期。这一时期的特征性表现包括核磁共振（MRI）上的骨髓水肿和关节积液，X线上的新月征和临床表现上突发的疼痛加重。越来越多的证据表明这些表现继发于软骨下骨骨折后的改变。值得注意的是，CT能够在鉴定软骨下骨骨折方面提供比MRI更多的信息，因此被认为是对围塌陷期分期最敏感的工具。围塌陷的出现表明股骨头坏死进一步进展的可能性大，同时在该期实施保髋手术有着较好的中远期效果。实际上，一旦塌陷高度超过2mm，全髋关节置换可能是更好的选择。 结论：具有明确的临床和影像特征的围塌陷期为股骨头坏死的保髋治疗提供了最后的良机。把围塌陷期作为股骨头坏死自然进展中的一个独立时期进行评估并指导治疗方案的选择是必须的。

Glucocorticoids could induce injury and apoptosis of bone microvascular endothelial cells (BMECs) in the femoral head, which is associated with the development of osteonecrosis and osteoporosis. Icariin is a prenylated flavonol glycoside isolated from Epimedium brevicornum, serving as the main active pharmaceutical constituent to treat bone loss. Currently, the impact of the autocrine activity of extracellular vesicles (EVs) induced by icariin on the glucocorticoid-induced injury of BMECs is still to be confirmed. In this study, EVs were isolated from BMECs treated with and without icariin by super-speed centrifugation. Although icariin treatment would not significantly change the size and total protein content of BMECs-derived EVs, expression of EVs-carried vascular endothelial growth factor (VEGF) and transforming growth factor β1 (TGF-β1) was enhanced and numerous miRNAs involved in cell proliferation and apoptosis were upregulated (e.g., hsa-miR-1469 and hsa-miR-133a-5p) or downregulated (e.g., hsa-miR-10b-5p) (p < 0.05). A total of 29 differentially expressed inflammatory factors were detected between the EVs secreted by BMECs from the Icariin-treated group and the Model group. The EVs secreted by BMECs could improve cell viability, decrease cell apoptosis, and promote cell migration and angiogenesis under the intervention of glucocorticoids. Meanwhile, icariin intervention could reinforce these protective effects of BMECs-derived EVs. To sum up, the present study indicates that icariin acts as a promising candidate for treating glucocorticoid-induced injury of BMECs and bone diseases, partially through the autocrine activity of EVs. In vivo or animal studies are still required to better understand the function of BMECs-derived EVs.

Background. Previous literatures have investigated the change of miR-20a expression level in the progression of multiple cancers and its influence on patients’ survival outcome, but results of now-available evidence are inconsistent.Objective. To elucidate the prognostic value of circulating and tissue-based miR-20a for patients with various cancers.Methods. A systematic search and review of eligible publications were carried out in three electronic databases including the Cochrane Library, PubMed, and Embase, and the methodological quality of included studies was assessed according to Newcastle-Ottawa Scale (NOS). Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for overall survival (OS), recurrence-free survival (RFS), disease-free survival (DFS), and progressive-free survival (PFS) of each study were pooled using a random effect model.Results. In total, 24 studies involving 4186 samples of multiple cancers published in 20 articles were included in the statistical analysis. As for circulating miR-20a, five kinds of cancers containing gastric cancer, lymphoma, glioblastoma, prostate cancer, and non-small-cell lung cancer reported upregulated level in patients compared with normal healthy control, and overexpressed circulating miR-20a could confer an unfavorable factor for OS (HR = 1.71, 95% CIs: 1.43 -2.04,p< 0.01) and DFS (HR = 1.90, 95% CIs: 1.45-2.49,p< 0.01). As for tissue-based samples, 6 kinds of malignancies including colorectal cancer, salivary adenoid cystic carcinoma, gallbladder carcinoma, colon cancer, gastrointestinal cancer, and alveolar rhabdomyosarcoma revealed upregulated miR-20a expression level compared with paired nontumorous tissue, of which high expression of miR-20a was significantly associated with poor OS (HR = 2.74, 95% CIs: 1.38-5.42,p< 0.01) and DFS (HR = 2.68, 95% CIs: 1.32-5.45,p< 0.01); meanwhile, other 5 tumors containing breast cancer, cutaneous squamous cell carcinoma, hepatocellular carcinoma, oral squamous cell carcinoma, and epithelial ovarian cancer demonstrated downregulated miR-20a expression level compared with benign tissue, of which low miR-20a expression was significantly related to shorter OS (HR = 3.48, 95% CIs: 2.00-6.06,p< 0.01) and PFS/RFS (HR = 4.05, 95% CIs: 2.89-5.66,p< 0.01).Conclusion. Change of circulating and tissue-based miR-20a expression possesses vital prognostic implication for human cancers. Augmented expression of circulating miR-20a predicts poor survival outcome for patients with cancers. Tissue-based miR-20a level may be upregulated or downregulated depending on cancer types; in the former condition, high expression of tissue miR-20a is a risk factor for unfavorable prognosis and in the latter condition low expression of tissue miR-20a is associated with shorter survival.

With advances in materials science and biology, there have been continuing innovations in the field of artificial joint prostheses. Cementless prostheses have the advantages of long service life, easy revision, and good initial stability and are widely used in artificial joint replacement. Coatings are the key to cementless prostheses and are at the heart of their excellent functionality. This article mainly studies the clinical application of hydroxyapatite (HA) coating, standard porous coating represented by Porocoat coating, and new high-porosity coating represented by Gription coating. The clinical application and biological functionalization of different artificial joint prosthesis surface coatings are clarified, and it provides a reference for the clinical selection and development of different prosthesis surface coating materials.

Background: During a seizure, there is a powerful and forceful contraction of muscles which may lead to fractures or joint dislocations. However, multiple periprosthetic hip fractures and joint dislocations secondary to seizures have not been reported. Case presentation: A 49-year-old male developed spontaneous and bilateral multiple periprosthetic hip fractures and joint dislocations (including displaced fracture of the proximal right femur, avulsion fracture of the left lesser trochanter, left acetabular fracture and bilateral joint dislocations) secondary to generalized convulsive seizures which occurred within few hours after bilateral total hip arthroplasties (THAs). Bilateral open reconstruction and fixation were performed on the 21st day after primary THAs and on 2-year follow-up, the patient showed satisfactory functional outcome. Conclusions: Multiple periprosthetic hip fractures and joint dislocations secondary to seizure are extremely rare, and treatment targets for these injuries should focus on fracture healing and limb function recovery. Craniocerebral operation could bring an elevated risk of seizure; meanwhile, subsequent corticosteroid replacement threapy was complicated by secondary osteoporosis. Therefore, anti-osteoporotic and anti-epileptic therapy should be considered in this type of patients to avoid fracture and dislocation after arthroplasty.