Efficacy of autologous bone marrow buffy coat grafting combined with core decompression in patients with avascular necrosis of femoral head: a prospective, double-blinded, randomized, controlled study

Introduction Avascular necrosis of femoral head (ANFH) is a progressive disease that often leads to hip joint dysfunction and even disability in young patients. Although the standard treatment, which is core decompression, has the advantage of minimal invasion, the efficacy is variable. Recent studies have shown that implantation of bone marrow containing osteogenic precursors into necrotic lesion of ANFH may be promising for the treatment of ANFH. Methods A prospective, double-blinded, randomized controlled trial was conducted to examine the effect of bone-marrow buffy coat (BBC) grafting combined with core decompression for the treatment of ANFH. Forty-five patients (53 hips) with Ficat stage I to III ANFH were recruited. The hips were allocated to the control group (core decompression + autologous bone graft) or treatment group (core decompression + autologous bone graft with BBC). Both patients and assessors were blinded to the treatment options. The clinical symptoms and disease progression were assessed as the primary and secondary outcomes. Results At the final follow-up (24 months), there was a significant relief in pain (P \u3c0.05) and clinical joint symptoms as measured by the Lequesne index (P \u3c0.05) and Western Ontario and McMaster Universities Arthritis Index (P \u3c0.05) in the treatment group. In addition, 33.3% of the hips in the control group have deteriorated to the next stage after 24 months post-procedure, whereas only 8% in the treatment group had further deterioration (P \u3c0.05). More importantly, the non-progression rates for stage I/II hips were 100% in the treatment group and 66.7% in the control group. Conclusion Implantation of the autologous BBC grafting combined with core decompression is effective to prevent further progression for the early stages of ANFH. Trial registration ClinicalTrials.gov identifier NCT01613612. Registered 13 December 2011

Black adzes in the Early Neolithic of Belgium: Contribution of the Raman microspectrometry and petrography in characterization and sourcing

Early Neolithic (Linear Pottery Culture) adzes originate from settlements and workshops accompany the neolithization of Belgium. They are made from a wide range of extraregional lithic raw materials such as metamorphic green rocks (amphibolite) and black volcanic rocks (“basalt’) beside more local or regional raw material as flints, light-coloured (sedimentary and lightly metamorphic) quartzites, black lydites (Cambrian nodular phtanite of Céroux-Mousty and Lower Namurian banded phtanites) and dark grey Lower Namurian silicified sandstones previously called “Micaceous sandstones of Horion-Hozémont’. The discovery of the workshop of Noirfontaine near the city of Liège in the 1970s and 1980s provides exceptional assemblage available for updating analytical studies. This research focuses on the multi-scale characterization, the discrimination and sourcing both Cambrian and Namurian black sedimentary rocks rich in secondary silica composing Early Neolithic adzes found in Belgium. Their black colour results from finely dispersed organic matter, but the absence of palynomorphs does not allow a biostratigraphic ascription. Additional petrographical analyses (Optical Petrography, Scanning Electron Microscope), X-ray diffraction, chemical analyses (Energy Dispersive Spectroscopy) and measuring the degree of graphitization of the organic matter through Raman microspectrometry have been decisive in identifying the geological and geographical provenances by comparing the acquired results with geological reference samples collected in the field or through reference collections. Cambrian lydites are coming from a very restricted area and were preferred to other more local rock sources

A systematic review of the concept and clinical applications of Bone Marrow Aspirate Concentrate in Orthopaedics

INTRODUCTION: Mesenchymal stem cells (MSC's) are believed to have multipotent plasticity with the capability to differentiate along multiple cell lineages such as cartilage, bone, tendon, muscle, and nerve. Such multipotency has the potential to play an important role in the repair and reconstruction of multiple tissues across a number of orthopaedic specialties. Bone marrow and fat are the most abundant and accessible source of MSC's with bone marrow aspirate the most commonly being reported to stimulate healing. METHODS: This review examines the current reported 20 Q2 clinical applications of bone marrow aspirate concentrate and its effectiveness. RESULTS: The published studies reported techniques of collection and preparation of BMAC in addition to its applications in a number of orthopaedic sub-specialities. Studies could be sub-categorised into: techniques of extraction, processing and microscopic examination of BMAC (31), reconstruction of osseous defects/non-union (20), treatment of avascular necrosis (9), repair of cartilage defects (8), treatment of sports injuries and tendon injury/repair (9), injection in regenerative therapy (4), treatment of spine conditions (4) including enhancing postoperative fusion and degenerative disc pathology and orthopaedic oncology (4). A few published studies combined the use of platelet-rich plasma (PRP) with BMAC (4) or compared them in different applications (5). CONCLUSIONS: BMAC has been used in bone, cartilage and tendon injuries with encouraging results

Stem cell therapy for the treatment of early stage avascular necrosis of the femoral head: a systematic review

BACKGROUND: Avascular necrosis (AVN) of the femoral head (FH) is believed to be caused by a multitude of etiologic factors and is associated with significant morbidity in younger populations. Eventually, the disease progresses and results in FH collapse. Thus, a focus on early disease management aimed at joint preservation by preventing or delaying progression is key. The use of stem cells (SC) for the treatment of AVN of the FH has been proposed. We undertook a systematic review of the medical literature examining the use of SC for the treatment of early stage (precollapse) AVN of the FH, in both pre-clinical and clinical studies. METHODS: Data collected included: Pre-clinical studies – model of AVN, variety and dosage of SC, histologic and imaging analyses. Clinical studies – study design, classification and etiology of AVN, SC dosage and treatment protocol, incidence of disease progression, patient reported outcomes, volume of necrotic lesion and hip survivorship. RESULTS: In pre-clinical studies, the use of SC uniformly demonstrated improvements in osteogenesis and angiogenesis, yet source of implanted SC was variable. In clinical studies, groups treated with SC showed significant improvements in patient reported outcomes; however hip survivorship was not affected. Discrepancies regarding dose of SC, AVN etiology and disease severity were present. CONCLUSIONS: Routine use of this treatment method will first require further research into dose and quality optimization as well as confirmed improvements in hip survivorship

PRP and BMAC for Musculoskeletal Conditions via Biomaterial Carriers.

Platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) are orthobiologic therapies considered as an alternative to the current therapies for muscle, bone and cartilage. Different formulations of biomaterials have been used as carriers for PRP and BMAC in order to increase regenerative processes. The most common biomaterials utilized in conjunction with PRP and BMAC clinical trials are organic scaffolds and natural or synthetic polymers. This review will cover the combinatorial strategies of biomaterial carriers with PRP and BMAC for musculoskeletal conditions (MsCs) repair and regeneration in clinical trials. The main objective is to review the therapeutic use of PRP and BMAC as a treatment option for muscle, bone and cartilage injuries

The STS pilot user development program

The planning and preparation activities and the results of the briefings associated with the Paris Air Show are described. A team of key personnel were available during the show to familiarize international users with the STS program and the space shuttle capabilities. Participation at the show included the operation of an STS booth at the U.S. pavilion, the presentation of several invitational briefings, and detailed discussions with individual organizations

Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients

The clinical application of cellular based therapies with ex vivo cultivation for the treatment of diseases of the musculoskeletal system has until now been limited. In particular, the advanced laboratory and technical effort necessary, regulatory issues as well as high costs are major obstacles. On the other hand, newly developed cell therapy systems permit intra-operative enrichment and application of mesenchymal and progenitor stem cells from bone marrow aspirate concentrate (BMAC) in one single operative session. The objective of the present clinical surveillance study was to evaluate new bone formation after the application of BMAC as well as to record any possible therapy-specific complication