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Nurrachman AS, Azhari A, Epsilawati L, Pramanik F. Temporal Pattern of micro-CT Angiography Vascular Parameters and VEGF mRNA Expression in Fracture Healing: a Radiograph and Molecular Comparison. Eur J Dent 2023. [PMID: 36716788 DOI: 10.1055/s-0042-1757466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Angiogenesis plays an important role in fracture healing with vascular endothelial growth factor (VEGF) as the main protein involved. Micro-computed tomography (CT) angiography may be used to analyze this revascularization with several parameters such as number of branches, total volume, and diameter. This systematic review is aimed to assess available studies on the temporal pattern of vascular imaging on micro-CT angiographs, especially in terms of the number of branches, total volume, and diameter as well as the temporal pattern of VEGF mRNA expression as the molecular comparison during bone fracture healing. This review was conducted according to the PRISMA guidelines. Electronic database searches were performed using PubMed, ProQuest, ScienceDirect, EBSCOhost, Taylor & Francis Online, and hand searching. The search strategy and keywords were adjusted to each database using the Boolean operators and other available limit functions to identify most relevant articles based on our inclusion and exclusion criteria. Screening and filtration were done in several stages by removing the duplicates and analyzing each title, abstract, and full-text in all included entries. Data extraction was done for syntheses to summarize the temporal pattern of each parameter. A total of 28 articles were eligible and met all criteria, 11 articles were synthesized in its angiograph's analysis, 16 articles were synthesized in its VEGF mRNA expression analysis, and 1 article had both parameters analyzed. The overall temporal pattern of both three micro-CT angiographic parameters and VEGF mRNA expression was in line qualitatively. The number of branches, total volume, and diameter of the blood vessels in micro-CT angiography showed an exponential rise at week 2 and decline at week 3 of fracture healing, with the VEGF mRNA expression concurrently showing a consistent pattern in the phase.
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Affiliation(s)
- Aga Satria Nurrachman
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Azhari Azhari
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Padjadjaran University, Bandung, West Java, Indonesia
| | - Lusi Epsilawati
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Padjadjaran University, Bandung, West Java, Indonesia
| | - Farina Pramanik
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Padjadjaran University, Bandung, West Java, Indonesia
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Casanova M, Schindeler A, Peacock L, Lee L, Schneider P, Little DG, Müller R. Characterization of the Developing Lacunocanalicular Network During Fracture Repair. JBMR Plus 2021; 5:e10525. [PMID: 34532613 PMCID: PMC8441443 DOI: 10.1002/jbm4.10525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/23/2021] [Accepted: 06/06/2021] [Indexed: 11/09/2022] Open
Abstract
Fracture repair is a normal physiological response to bone injury. During the process of bony callus formation, a lacunocanalicular network (LCN) is formed de novo that evolves with callus remodeling. Our aim was the longitudinal assessment of the development and evolution of the LCN during fracture repair. To this end, 45 adult wild‐type C57BL/6 mice underwent closed tibial fracture surgery. Fractured and intact contralateral tibias were harvested after 2, 3, and 6 weeks of bone healing (n = 15/group). High‐resolution micro–computed tomography (μCT) and deconvolution microscopy (DV) approaches were applied to quantify lacunar number density from the calluses and intact bone. On histological sections, Goldner's trichrome staining was used to assess lacunar occupancy, fluorescein isothiocyanate staining to visualize the canalicular network, and terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate‐biotin nick end labeling (TUNEL) staining to examine osteocyte apoptosis. Analysis of μCT scans showed progressive decreases in mean lacuna volume over time (−27% 2–3 weeks; −13% 3–6 weeks). Lacunar number density increased considerably between 2 and 3 weeks (+156%). Correlation analysis was performed, showing a positive linear relationship between canalicular number density and trabecular thickness (R2 = 0.56, p < 0.001) and an inverse relationship between mean lacuna volume and trabecular thickness (R2 = 0.57, p < 0.001). Histology showed increases in canalicular number density over time (+22% 2–3 weeks, +51% 3–6 weeks). Lacunar occupancy in new bone of the callus was high (>90%), but the old cortical bone within the fracture site appeared necrotic as it underwent resorption. In conclusion, our data shows a progressive increase in the complexity of the LCN over time during fracture healing and demonstrates that this network is initiated during the early stages of repair. Further studies are needed to address the functional importance of osteocytes in bone healing, particularly in detecting and translating the effects of micromotion in the fracture. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Aaron Schindeler
- Orthopaedic Research & Biotechnology The Children's Hospital at Westmead Westmead Australia.,Discipline of Child and Adolescent Health University of Sydney Camperdown Australia
| | - Lauren Peacock
- Orthopaedic Research & Biotechnology The Children's Hospital at Westmead Westmead Australia
| | - Lucinda Lee
- Orthopaedic Research & Biotechnology The Children's Hospital at Westmead Westmead Australia.,Discipline of Child and Adolescent Health University of Sydney Camperdown Australia
| | - Philipp Schneider
- Institute for Biomechanics ETH Zurich Zurich Switzerland.,Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences University of Southampton Southampton UK.,High-Performance Vision Systems, Center for Vision, Automation & Control Austrian Institute of Technology (AIT) Vienna Austria
| | - David G Little
- Orthopaedic Research & Biotechnology The Children's Hospital at Westmead Westmead Australia.,Discipline of Child and Adolescent Health University of Sydney Camperdown Australia
| | - Ralph Müller
- Institute for Biomechanics ETH Zurich Zurich Switzerland
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Liu WC, Chen S, Zheng L, Qin L. Angiogenesis Assays for the Evaluation of Angiogenic Properties of Orthopaedic Biomaterials - A General Review. Adv Healthc Mater 2017; 6. [PMID: 28135051 DOI: 10.1002/adhm.201600434] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/04/2016] [Indexed: 01/07/2023]
Abstract
Vascularization is an essential process in bone formation, remodeling and regeneration during both bone development and fracture repair. Vascularization remains a big challenge directly leading to the final success of newly regenerated bone. In this review, the advantages and disadvantages of different angiogenesis assays and bone defect models are described in details for investigating revascularization of materials of interest. Unlike conventional angiogenesis study with growth factors or pharmaceutical molecules performed in two-dimension, special considerations are taken into account whether these assays can be translated for testing three-dimensional implantable devices. Over the years, accurate and quantifiable in vitro, ex vivo and in vivo assays have been extensively demonstrated to be useful in examining how new blood vessels grow. These methods can contribute to the fundamental understanding of angiogenic properties of the materials, but a bone defect model is still pivotal in order to understand the cascade actions of angiogenesis along with bone formation. Finally, angiogenesis and osteogenesis are both complex processes interacting with each other, the choice of which assay to be performed should adequately address the clinical relevance and reflect the sequence of responses of revascularization of the test materials.
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Affiliation(s)
- Wai Ching Liu
- Musculoskeletal Research Laboratory; Department of Orthopaedics & Traumatology; The Chinese University of Hong Kong; 5/F, Clinical Science Building, Prince of Wales Hospital Shatin Hong Kong SAR PR China
| | - Shihui Chen
- Musculoskeletal Research Laboratory; Department of Orthopaedics & Traumatology; The Chinese University of Hong Kong; 5/F, Clinical Science Building, Prince of Wales Hospital Shatin Hong Kong SAR PR China
- Pathology Center; Shanghai General Hospital/Faculty of Basic Medicine; Shanghai Jiao Tong University School of Medicine; Shanghai PR China
| | - Lizhen Zheng
- Musculoskeletal Research Laboratory; Department of Orthopaedics & Traumatology; The Chinese University of Hong Kong; 5/F, Clinical Science Building, Prince of Wales Hospital Shatin Hong Kong SAR PR China
| | - Ling Qin
- Musculoskeletal Research Laboratory; Department of Orthopaedics & Traumatology; The Chinese University of Hong Kong; 5/F, Clinical Science Building, Prince of Wales Hospital Shatin Hong Kong SAR PR China
- Translational Medicine R&D Center; Institute of Biomedical and Health Engineering; Shenzhen Institutes of Advanced Technology; Chinese Academy of Sciences; Shenzhen PR China
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Polan DF, Brady SL, Kaufman RA. Tissue segmentation of computed tomography images using a Random Forest algorithm: a feasibility study. Phys Med Biol 2016; 61:6553-69. [PMID: 27530679 DOI: 10.1088/0031-9155/61/17/6553] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is a need for robust, fully automated whole body organ segmentation for diagnostic CT. This study investigates and optimizes a Random Forest algorithm for automated organ segmentation; explores the limitations of a Random Forest algorithm applied to the CT environment; and demonstrates segmentation accuracy in a feasibility study of pediatric and adult patients. To the best of our knowledge, this is the first study to investigate a trainable Weka segmentation (TWS) implementation using Random Forest machine-learning as a means to develop a fully automated tissue segmentation tool developed specifically for pediatric and adult examinations in a diagnostic CT environment. Current innovation in computed tomography (CT) is focused on radiomics, patient-specific radiation dose calculation, and image quality improvement using iterative reconstruction, all of which require specific knowledge of tissue and organ systems within a CT image. The purpose of this study was to develop a fully automated Random Forest classifier algorithm for segmentation of neck-chest-abdomen-pelvis CT examinations based on pediatric and adult CT protocols. Seven materials were classified: background, lung/internal air or gas, fat, muscle, solid organ parenchyma, blood/contrast enhanced fluid, and bone tissue using Matlab and the TWS plugin of FIJI. The following classifier feature filters of TWS were investigated: minimum, maximum, mean, and variance evaluated over a voxel radius of 2 (n) , (n from 0 to 4), along with noise reduction and edge preserving filters: Gaussian, bilateral, Kuwahara, and anisotropic diffusion. The Random Forest algorithm used 200 trees with 2 features randomly selected per node. The optimized auto-segmentation algorithm resulted in 16 image features including features derived from maximum, mean, variance Gaussian and Kuwahara filters. Dice similarity coefficient (DSC) calculations between manually segmented and Random Forest algorithm segmented images from 21 patient image sections, were analyzed. The automated algorithm produced segmentation of seven material classes with a median DSC of 0.86 ± 0.03 for pediatric patient protocols, and 0.85 ± 0.04 for adult patient protocols. Additionally, 100 randomly selected patient examinations were segmented and analyzed, and a mean sensitivity of 0.91 (range: 0.82-0.98), specificity of 0.89 (range: 0.70-0.98), and accuracy of 0.90 (range: 0.76-0.98) were demonstrated. In this study, we demonstrate that this fully automated segmentation tool was able to produce fast and accurate segmentation of the neck and trunk of the body over a wide range of patient habitus and scan parameters.
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Affiliation(s)
- Daniel F Polan
- Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, MI, USA. Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis TN, USA
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Bagno A, Martini R. Wavelet analysis of the Laser Doppler signal to assess skin perfusion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:7374-7. [PMID: 26737995 DOI: 10.1109/embc.2015.7320095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The hemodynamics of skin microcirculation can be clinically assessed by means of Laser Doppler Fluxmetry. Laser Doppler signals show periodic oscillations because of fluctuations of microvascular perfusion (flowmotion), which are sustained by contractions and relaxations of arteriolar walls rhythmically changing vessels diameter (vasomotion). The wavelet analysis applied to Laser Doppler signals displays six characteristic frequency intervals, from 0.005 to 2 Hz. Each interval is assigned to a specific structure of the cardiovascular system: heart, respiration, vascular myocites, sympathetic terminations, and endothelial cells (dependent and independent on nitric oxide). Therefore, mechanisms of skin perfusion can be investigated through wavelet analysis. In the present work, examples of methods and results of wavelet analysis applied to Laser Doppler signals are reported. Laser Doppler signals were acquired in two groups of patients to check possible changes in vascular activities, before and after occlusive reactive hyperaemia, and before and after revascularization.
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Popa SO, Ferrari M, Andreozzi GM, Martini R, Bagno A. Wavelet analysis of skin perfusion to assess the effects of FREMS therapy before and after occlusive reactive hyperemia. Med Eng Phys 2015; 37:1111-5. [PMID: 26391066 DOI: 10.1016/j.medengphy.2015.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/03/2015] [Accepted: 08/19/2015] [Indexed: 11/30/2022]
Abstract
Laser Doppler Fluxmetry is used to evaluate the hemodynamics of skin microcirculation. Laser Doppler signals contain oscillations due to fluctuations of microvascular perfusion. By performing spectral analysis, six frequency intervals from 0.005 to 2 Hz have been identified and assigned to distinct cardiovascular structures: heart, respiration, vascular myocites, sympathetic terminations and endothelial cells (dependent and independent on nitric oxide). Transcutaneous electrical pulses are currently applied to treat several diseases, i.e. neuropathies and chronic painful leg ulcers. Recently, FREMS (Frequency Rhythmic Electrical Modulation System) has been applied to vasculopathic patients, too. In this study Laser Doppler signals of skin microcirculation were measured in five patients with intermittent claudication, before and after the FREMS therapy. Changes in vascular activities were assessed by wavelet transform analysis. Preliminary results demonstrate that FREMS induces alterations in vascular activities.
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Affiliation(s)
- Stefan Octavian Popa
- Department of Industrial Engineering, University of Padova, via Marzolo 9, 35131 Padova, Italy
| | - Myriam Ferrari
- Department of Industrial Engineering, University of Padova, via Marzolo 9, 35131 Padova, Italy
| | - Giuseppe Maria Andreozzi
- UOC of Angiology, "Azienda Ospedale" University of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Romeo Martini
- UOC of Angiology, "Azienda Ospedale" University of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Andrea Bagno
- Department of Industrial Engineering, University of Padova, via Marzolo 9, 35131 Padova, Italy.
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Effect of fixation on neovascularization during bone healing. Med Eng Phys 2014; 36:1436-42. [PMID: 25080898 DOI: 10.1016/j.medengphy.2014.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/28/2014] [Accepted: 07/02/2014] [Indexed: 11/20/2022]
Abstract
Fixation and vascularity after bone fracture are two critical factors for successful healing, and their influences on bone healing have been studied by many researchers. This research aims to obtain three-dimensional (3D) reconstruction images of neovascularization of the soft tissues surrounding the fracture with vascular perfusion and micro-computer tomography (micro-CT) imaging, and to investigate the effect of stable fixation on neovascularization and the pattern of vascularity during the process of bone healing. To accomplish this, 36 Sprague-Dawley (SD) rats underwent mid-shaft transverse osteotomy of the right tibia. Half of them received stable fixation with a newly custom-designed external fixator (FSF, the group of fracture with stable fixation), while the rest received no fixation (FNF, the group of fracture with no fixation). The results indicated that FNF samples had more transversal vascular distribution than FSF samples; FSF samples had more longitudinal vascular distribution than FNF samples; and the spatio-temporal pattern of vascularity in FSF samples was more similar to that in the control group (CON, the group without fracture) than that in FNF samples. At the time of 2 and 4 weeks postoperatively, FNF samples had significantly higher vessel volume ratio (VV/TV), larger vessel number (VN) and higher vessel surface density (VS/TV) than CON samples. At all sacrifice times, FSF samples contained significantly higher VV/TV, VN and VS/TV values compared with FNF samples. In summary, neovascularization and its pattern are obviously influenced by the mechanical fixation. Stable fixation can promote longitudinal vascularity pattern formation, which tends to be similar to the natural vascularity pattern, and this benefits the inter-fragmentary blood fluid connectivity during bone healing process.
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Abstract
Angiogenesis is a vital component of bone healing. The formation of the new blood vessels at the fracture site restores the hypoxia and nutrient deprivation found at the early stages after fracture whilst at a later stage facilitates osteogenesis by the activity of the osteoprogenitor cells. Emerging evidence suggests that there are certain molecules and gene therapies that could promote new blood vessel formation and as a consequence enhance the local bone healing response. This article summarizes the current in vivo evidence on therapeutic approaches aiming at the augmentation of the angiogenic signalling during bone repair.
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