Suppression of Bone Necrosis around Tooth Extraction Socket in a MRONJ-like Mouse Model by E-rhBMP-2 Containing Artificial Bone Graft Administration

Medication-related osteonecrosis of the jaw (MRONJ) is related to impaired bone healing conditions in the maxillomandibular bone region as a complication of bisphosphonate intake. Although there are several hypotheses for the onset of MRONJ symptoms, one of the possible causes is the inhibition of bone turnover and blood supply leading to bone necrosis. The optimal treatment strategy for MRONJ has not been established either. BMP-2, a member of the TGF-β superfamily, is well known for regulating bone remodeling and homeostasis prenatally and postnatally. Therefore, the objectives of this study were to evaluate whether cyclophosphamide/zoledronate (CY/ZA) induces necrosis of the bone surrounding the tooth extraction socket, and to examine the therapeutic potential of BMP-2 in combination with the hard osteoinductive biomaterial, β-tricalcium phosphate (β-TCP), in the prevention and treatment of alveolar bone loss around the tooth extraction socket in MRONJ-like mice models. First, CY/ZA was intraperitoneally administered for three weeks, and alveolar bone necrosis was evaluated before and after tooth extraction. Next, the effect of BMP-2/β-TCP was investigated in both MRONJ-like prevention and treatment models. In the prevention model, CY/ZA was continuously administered for four weeks after BMP-2/β-TCP transplantation. In the treatment model, CY/ZA administration was suspended after transplantation of BMP-2/β-TCP. The results showed that CY/ZA induced a significant decrease in the number of empty lacunae, a sign of bone necrosis, in the alveolar bone around the tooth extraction socket after tooth extraction. Histological analysis showed a significant decrease in the necrotic alveolar bone around tooth extraction sockets in the BMP-2/β-TCP transplantation group compared to the non-transplanted control group in both MRONJ-like prevention and treatment models. However, bone mineral density, determined by micro-CT analysis, was significantly higher in the BMP-2/β-TCP transplanted group than in the control group in the prevention model only. These results clarified that alveolar bone necrosis around tooth extraction sockets can be induced after surgical intervention under CY/ZA administration. In addition, transplantation of BMP-2/β-TCP reduced the necrotic alveolar bone around the tooth extraction socket. Therefore, a combination of BMP-2/β-TCP could be an alternative approach for both prevention and treatment of MRONJ-like symptoms.

ROLE OF PANCHTIKTA KSHIRA BASTI IN MANAGEMENT OF AVASCULAR NECROSIS: A CASE STUDY

Avascular necrosis additionally referred to as osteo-necrosis or Ischemic bone necrosis is a condition that occurs when there is a loss of blood supply of bone. An interruption in the blood supply causes bone cells to die. AVN of femoral head is that the commonest sort of necrosis affecting the bone. In Ayurveda, It correlated with asthimajjagata vaat (musculoskeletal disorder). An effort has been made within the present study to gauge the efficacy of panchtikta kshir basti in conservative management of femoral head necrosis of the bone. In Modern medicine, no any unique remedy as opposed to surgical operation is available.

Non-Fourier bioheat model for bone grinding with application to skull base neurosurgery

Bone grinding is used to remove the skull bone and access tumors through the nasal passage during cranial base neurosurgery. The generated heat of the spherical diamond tool propagates and could damage the nerves or coagulate the arteries blood. Little is known about the non-Fourier behavior of heat propagation during bone grinding. Therefore, this study develops an analytical model of the hyperbolic Pennes bioheat transfer equation (HPBTE) to calculate the three-dimensional temperature and necrosis in the grinding region. In vitro experimental investigations were carried out, and the contact zone temperature was measured using an infrared thermography system to validate the proposed thermal model. The results demonstrate that the HPBTE provides more reliable temperature evaluation and thermal damage than Fourier or parabolic heat transfer equation (PHTE). Due to the low thermal diffusivity of the bone, the lower grinding feed rate leads to higher temperature amplitude and a smaller radius of the affected zone in the surface and depth of the bone. Also, the intensity of bone necrosis decreases with the increase of the feed rate, and the shape of the damage zone becomes stretched. This analytical model can assess the potential risk of the surgery before clinical trials. Also, it could be used for comparing the different operating conditions to minimize bone necrosis and improve the control process in neurosurgeries.

AYURVEDIC INSIGHTS OF AVASCULAR NECROSIS OF FEMORAL HEAD

Avascular necrosis of the femur head (AVNFH) is a debilitating disease caused due to the use of alcohol, steroids, following trauma or unclear (idiopathic) etiology, affecting mostly the middle aged population. Clinically AVNFH is associated with impaired blood supply to the femoral head resulting in bone necrosis and collapse.In Ayurveda, there is no direct reference of disease resembling to Avascular necrosis of femoral head, hence it can be understand on the basis of Vikaraprakriti of disease caused by vitiation of Dosa, Adhisthana (abodesite) and Hetu (causes of vitiation of Dosa). In the present study an effort has been made to understand AVN on the ground of Ayurveda.

COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

Background: Mucormycosis is a life-threatening invasive fungal infection most commonly observed in immunocompromised patients. Throughout the COVID-19 pandemic, a growing number of Mucorales associated infections, now termed COVID-19 associated mucormycosis (CAM), have been reported. Despite an increase in fatality reports, no cases of rhino-orbital CAM complicated with gangrenous bone necrosis have been described in the literature to date. Case: A 56-year-old male with a recent COVID-19 diagnosis developed rhino-orbital mucormycosis after 22 days of treatment with dexamethasone. Cultures and histopathological assessment of tissue biopsy confirmed the diagnosis. The patient survived after treatment with amphotericin B. Conclusions: Mucormycosis is an invasive fungal infection affecting mostly immunocompromised patients. Along with the COVID-19 pandemic, the inappropriate use of steroids, in addition to concurrent risk factors, such as diabetes, has led to an increase in the occurrence of these devastating mycoses, leading to the development of severe presentations and complications, as observed in many cases. Early diagnosis and prompt treatment are crucial in order to avoid dissemination and fatal outcomes.

Treatment of Advanced Lunate Bone Necrosis by Individualized Bone Cement Prosthetic Replacement

Objective: The aim of this study is to prospectively analyze the clinical effect of an individualized bone cement prosthetic replacement in treating advanced lunate bone necrosis. Methods: Since 2006, a total of 19 Lichtman stage III and IV aseptic lunate bone necrosis patients with a wrist height ratio ≥0.5 were included, the last visit time was three years after operation. The statistically significant differences in range of motion, (Visual Analogue Scale/Score, VAS) score, Cooney score, grasp force, wrist height ratio (to the capitate bone), and radio scaphoid angle of the affected wrist joint were observed before the operation and at the last visit (p<0.05). Results: There were no statistically significant differences in the axial line and maximum diameter of the lunate bone between the healthy side and the affected side (p>0.05). Conclusion: The surgical method can restore the original anatomic structure of wrist joint, play an important role in recovering the movement function of wrist joint, and has a significant effect on wrist pain and few complications.

Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans

This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.