Induced neural stem cells regulate microglial activation through Akt-mediated upregulation of CXCR4 and Crry in a mouse model of closed head injury

Microglial activation that occurs rapidly after closed head injury may play important and complex roles in neuroinflammation-associated neuronal damage and repair.We previously reported that induced neural stem cells can modulate the behavior of activated microglia via CXCL12/CXCR4 signaling,influencing their activation such that they can promote neurological recovery.However,the mechanism of CXCR4 upregulation in induced neural stem cells remains unclear.In this study,we found that nuclear factor-κB activation induced by closed head injury mouse serum in microglia promoted CXCL12 and tumor necrosis factor-αexpression but suppressed insulin-like growth factor-1 expression.However,recombinant complement receptor 2-conjugated Crry(CR2-Crry)reduced the effects of closed head injury mouse serum-induced nuclear factor-κB activation in microglia and the levels of activated microglia,CXCL12,and tumor necrosis factor-α.Additionally,we observed that,in response to stimulation(including stimulation by CXCL12 secreted by activated microglia),CXCR4 and Crry levels can be upregulated in induced neural stem cells via the interplay among CXCL12/CXCR4,Crry,and Akt signaling to modulate microglial activation.In agreement with these in vitro experimental results,we found that Akt activation enhanced the immunoregulatory effects of induced neural stem cell grafts on microglial activation,leading to the promotion of neurological recovery via insulin-like growth factor-1 secretion and the neuroprotective effects of induced neural stem cell grafts through CXCR4 and Crry upregulation in the injured cortices of closed head injury mice.Notably,these beneficial effects of Akt activation in induced neural stem cells were positively correlated with the therapeutic effects of induced neural stem cells on neuronal injury,cerebral edema,and neurological disorders post–closed head injury.In conclusion,our findings reveal that Akt activation may enhance the immunoregulatory effects of induced neural stem cells on microglial activation via upregulation of CXCR4 and Crry,thereby promoting induced neural stem cell–mediated improvement of neuronal injury,cerebral edema,and neurological disorders following closed head injury.

Restless head syndrome:A retrospective study

BACKGROUND Restless legs syndrome(RLS)is characterized by an urge to move with an unpleasant sensation in the lower limbs.RLS typically affects the legs.However,it can also affect several other body regions,such as the arms,abdomen,face,neck,head,and genital area.There are only a few reports of the RLS variant affecting the head.AIM To assess the epidemiological,clinical,and other aspects of the RLS variant affecting the head.METHODS We conducted a retrospective study of 17 adult patients(>18 years)who met the RLS criteria and simultaneously experienced RLS-like symptoms in the head.RESULTS The median age at which symptoms appeared was 41.6 years.Males and females were equally affected(1.1:1).All 17 patients had uncomfortable sensations in the lower legs.Insomnia or disturbed sleep was the most common comorbidity(n=16,88.2%).However,headache was the most common presenting or primary symptom(n=10,70.5%).Dizziness or an abnormal sensation in the head was the second most common presenting symptom(5 patients,29.4%).Other presenting features were leg pain,backache,and generalized body pain.All patients responded favorably to dopaminergic medications.CONCLUSION If RLS-related unpleasant sensations and pain are felt in the head,they may be misinterpreted as headache,dizziness,or psychosomatic symptoms.RLS and headaches in a subset of patients may be two phenotypic manifestations of the same disorder.

Competence of clinical teachers:A survey on perception of masters of nursing specialist postgraduates, their clinical teachers, and head nurses

Objectives:To explore the current admittance situation of clinical teachers for masters of nursing specialist(MNS)postgraduates and to test the competence of clinical teachers in self-evaluation and other evaluations.Methods:In this cross-sectional study,using a random number table,we chose 80 MNS postgraduates under clinical practice,their clinical teachers,and head nurses each from six hospitals in Hunan and Guangdong.The participants were tested on the basis of the Clinical Teachers'Competence Inventory of MNS Postgraduates.The competences of clinical teachers were evaluated by the three groups of participants.Results:The aggregated scores of teacher competence as evaluated by the MNS postgraduates(181.33±24.95)were lower than those assigned by both clinical teachers(190.75±24.30)and their head nurses(198.53±18.90),with significant differences in all dimensions except for clinical managing ability.The five highest rated items from all participants focused on the teachers'clinical nursing ability,and the five lowest rated items were mainly about their clinical research ability.Conclusion:The evaluation from MNS postgraduates is obviously lower than the self-evaluation of clinical teachers,and all participants are aware of the deficiency in research ability of the teachers.Thus,the admittance and examination of clinical teachers should be controlled strictly.Training should be carried out immediately to strengthen their comprehensive abilities,especially their research ability.

The challenges that head nurses confront on financial management today:A qualitative study

Aim: To explore challenges that Chinese head nurses confront on financial management from the perspective of different levels of nursing and non-nursing managers and to provide contemporary nurse managers with suitable supports.Methods: Eighteen nursing leaders in different levels were divided into two groups: Junior Leadership Group (head nurses) and Senior Leadership Group (nurse coordinator, nurse executive, and vice-president of the hospital). All the subjects were invited to participate in a semi-structured interview. The interviews were audio-taped and transcribed, and data were analyzed using a comparative content approach. Results: The four following challenges that head nurses confront on financial management practice were identified from the research findings: 1) lack of intrinsic motivation;2) insufficient training and edu-cation on financial management and nursing economics;3) desires for cross-uniting communication and cooperation;4) insufficient reference managerial tool. Conclusions: The confusion confronted by head nurses in Changsha include three aspects: managerial roles, managerial training, and managerial tools. Cooperative management model, evidence-based management training, and data-driven tools will contribute to improving the financial management capacity of nurse managers.

融合MacBERT和Talking⁃Heads Attention实体关系联合抽取模型

针对现有的医学文本关系抽取任务模型在训练过程中存在语义理解能力不足,可能导致关系抽取的效果不尽人意的问题,文中提出一种融合MacBERT和Talking⁃Heads Attention的实体关系联合抽取模型。该模型首先利用MacBERT语言模型来获取动态字向量表达,MacBERT作为改进的BERT模型,能够减少预训练和微调阶段之间的差异,从而提高模型的泛化能力;然后,将这些动态字向量表达输入到双向门控循环单元(BiGRU)中,以便提取文本的上下文特征。BiGRU是一种改进的循环神经网络(RNN),具有更好的长期依赖捕获能力。在获取文本上下文特征之后,使用Talking⁃Heads Attention来获取全局特征。Talking⁃Heads Attention是一种自注意力机制,可以捕获文本中不同位置之间的关系,从而提高关系抽取的准确性。实验结果表明,与实体关系联合抽取模型GRTE相比,该模型F1值提升1%,precision值提升0.4%,recall值提升1.5%。

Long non-coding RNA H19 regulates neurogenesis of induced neural stem cells in a mouse model of closed head injury

Stem cell-based therapies have been proposed as a potential treatment for neural regeneration following closed head injury.We previously reported that induced neural stem cells exert beneficial effects on neural regeneration via cell replacement.However,the neural regeneration efficiency of induced neural stem cells remains limited.In this study,we explored differentially expressed genes and long non-coding RNAs to clarify the mechanism underlying the neurogenesis of induced neural stem cells.We found that H19 was the most downregulated neurogenesis-associated lnc RNA in induced neural stem cells compared with induced pluripotent stem cells.Additionally,we demonstrated that H19 levels in induced neural stem cells were markedly lower than those in induced pluripotent stem cells and were substantially higher than those in induced neural stem cell-derived neurons.We predicted the target genes of H19 and discovered that H19 directly interacts with mi R-325-3p,which directly interacts with Ctbp2 in induced pluripotent stem cells and induced neural stem cells.Silencing H19 or Ctbp2 impaired induced neural stem cell proliferation,and mi R-325-3p suppression restored the effect of H19 inhibition but not the effect of Ctbp2 inhibition.Furthermore,H19 silencing substantially promoted the neural differentiation of induced neural stem cells and did not induce apoptosis of induced neural stem cells.Notably,silencing H19 in induced neural stem cell grafts markedly accelerated the neurological recovery of closed head injury mice.Our results reveal that H19 regulates the neurogenesis of induced neural stem cells.H19 inhibition may promote the neural differentiation of induced neural stem cells,which is closely associated with neurological recovery following closed head injury.

Enhancing competency of clinical research nurses:A comprehensive training and evaluation framework

The Sun et al's training program for clinical research nurses(CRNs)in the World Journal of Clinical Cases is a comprehensive and scientific approach.It includes structured frameworks for CRN training,aiming to improve CRN competency.This program emphasizes practical abilities,updates training content,and improves evaluation methods.The cultivation of CRN talents focuses on enhancing the training system,establishing a multifaceted evaluation framework,and continuously refining the training programs.Regular feedback and evalua-tion are essential to improve CRNs'competency in practical settings.

Culturally competent care across borders: Implementing culturally responsive teaching for nurses in diverse workforces

The migration of healthcare professionals,including nurses,is a global phenomenon.It is driven by various factors,including the pursuit of better opportunities,living conditions,and professional development,as well as political instability or conflict in their home countries.The World Health Organization(WHO)has noted that high-income countries often rely on foreign-trained nurses to fill gaps in their healthcare systems[1].For instance,as of 2021,over 40%(52 million)of all nurses in the United States(US)were expatriates[2].In the United Kingdom(UK),the percentage of expatriate nurses was even higher,reaching approximately 18%in 2021[3].Owing to globalization and migration,healthcare providers must possess cultural competence to deliver improved care[4,5].Culturally responsive teaching(CRT)is rooted in the idea that culture plays a vital role in shaping people’s behaviors,beliefs,values,and communication styles[6].Furthermore,these cultural factors influence patients’perspectives on health,illness,healing,and their preferences for care and communication[7].By recognizing and embracing these cultural differences,nurses can provide more effective and compassionate care to their diverse patient population[8].

Knowledge, Attitude, and Practice of Using Helmets in Children amongst Parents to Prevent Head Injuries: A Cross-Sectional Study in Riyadh, Saudi Arabia

Objectives: The primary objective was to characterize the range of Knowledge, Attitude, and Practice (KAP) of Helmet use in children amongst parents to prevent head injuries and death. Methods: This is a cross-sectional study, done by online survey using a snowball sampling technique, the number of included responses were 386 parents (Male and female) living in Riyadh Aged 21 - 60 years old or above. Results: The study showed that there is a difference in Parents’ belief in the importance of helmet use while riding a Bicycle vs Motorcycle/Quad bike and that was affected by parents’ education level, almost all the people who answered the survey (76.7%) agree that it is important for their children to wear a helmet when riding both a Bicycle and a Motorcycle or Quadbike with a cumulative percentage of (93.8%). And almost all agreed on multiple approaches to help increase helmet use be it by forcing rental shops to give out helmets, forcing sellers to recommend the use of helmets, increasing awareness campaigns, and imposing fines for not wearing helmets. Conclusions: This study is the first to explore Family helmet use while riding Bicycles and Motorcycles/Quad bikes. Although Parent’s belief in the importance of helmet use for their children was high, it is clear that the level of practice is low. With that the risk of head injuries might be high, our findings suggest that safety interventions for increasing pediatric helmet use are needed to increase helmet use and reduce the risk of head injury and hospitalization.

Factors influencing ruminative thinking behaviours in nurses:a cross-sectional study of 858 subjects in a tertiary care hospital

To the editor:Nurses play a vital role in healthcare by providing direct medical care to patients,and their mental well-being significantly impacts the quality of service and patient satisfaction.^(1)Ruminative thinking involves repetitive thoughts about negative feelings,their causes and consequences.This common psychological behaviour innurses can significantly impact their self-evaluation and result in feelings of worthlessness.

Factors Promoting Retention of Nurses in Three Private Hospitals of Lahore: A Cross Sectional Descriptive Survey

Introduction: Pakistan has a large number of professional nurses but a higher rate of turnover contributes towards the shortage of nurses which is intensified by nurses’ immigration, lack of recruitment of new nurses and retirement of senior nurses. Aim: The study aimed at examining the factors that increase retention of nurses. Research Method: The study is descriptive cross sectional with a sample of 150 nurses including both the genders, from 3 private hospitals located in Pakistan. A convenient sampling technique was used. The data collection was done through close ended questionnaires based on 20 questions. Data collection was done quantitatively and then data was entered in SPSS. Correlation and regression tests were performed. Findings: The analysis revealed that 91.3% nurses are loyal to their hospitals but, 8.7%nurses can switch the hospital for different reasons. It was also found that the idea of leaving the job based on the intention of moving to abroad and public sector was higher than the retirement and other causes. Resultantly, enhancements in nurses’ work environments have the ability to decrease nurses’ job burnout and turnover and increase patients’ satisfaction. Recommendations: Hospital leaders should implement effective strategies to encourage nurses to continue their job by motivation, strengthening management skills within the hospital and improving a positive work environment by promoting teamwork, continuous learning, trust, respect and flexible arrangements which can lead towards achieving better results.However, further studies quantitatively and qualitatively can explore more factors related to dissatisfaction of nurses. Health systems policy makers should lead by developing related strategies for the retention of nurses.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

Experimental and numerical simulation study on forced ventilation and dust removal of coal mine heading surface

In order to study the problems of unreasonable airflow distribution and serious dust pollution in a heading surface,an experimental platform for forced ventilation and dust removal was built based on the similar principles.Through the similar experiment and numerical simulation,the distribution of airflow field in the roadway and the spatial and temporal evolution of dust pollution under the conditions of forced ventilation were determined.The airflow field in the roadway can be divided into three zones:jet zone,vortex zone and reflux zone.The dust concentration gradually decreases from the head to the rear of the roadway.Under the forced ventilation conditions,there is a unilateral accumulation of dust,with higher dust concentrations away from the ducts.The position of the equipment has an interception effect on the dust.The maximum error between the test value and the simulation result is 12.9%,which verifies the accuracy of the experimental results.The research results can provide theoretical guidance for the application of dust removal technology in coal mine.

基于改进Double-Head RCNN的无人机航拍图像小目标检测算法

为解决无人机航拍图像中小目标特征信息少且容易被噪声干扰导致现有算法漏检率和误检率高的问题,提出一种改进Double-Head Region-卷积神经网络(RCNN)的无人机航拍图像小目标检测算法。在骨干网络ResNet-50上引入Transformer和可变形卷积(DCN)模块,更有效提取小目标特征信息和语义信息;提出一种基于内容感知特征重组(CARAFE)的特征金字塔网络(FPN)结构模块,解决特征融合过程中小目标被背景噪声干扰而丢失特征信息的问题;在区域建议网络中针对小目标尺度分布特点重新设置Anchor生成尺度,进一步提升小目标检测性能。在VisDrone-DET2021数据集上的实验结果表明:所提算法能提取更具有表征能力的小目标特征信息和语义信息,对比Double-Head RCNN算法,所提算法的参数量增加了9.73×10^(6),FPS损失了0.6,但是AP、AP50和AP75分别提升了2.6%、6.2%和2.1%,APs提升了3.1%。

Tilapia Head Glycolipid Alleviates Indomethacin-Induced Gastric Ulcer via Regulating Oxidative Stress and Inflammation Through COX/PGE2 Signaling Pathway in Adult Rats

The aim of this experiment was to investigate the ameliorative effect and molecular mechanism of tilapia head glycolipid(TH-GL)on indomethacin(IDM)-induced gastric ulcer in male Sprague Dawley(SD)rats.The gastric ulcer model was established by oral administration of 30mgkg^(-1) IDM after 7 days of TH-GL or omeprazole(OME)administration in rats.Then the macroscopic gastric injury symptoms,gastric mucosa protective factor cyclooxygenase 1(COX-1),cyclooxygenase 2(COX-2),prostaglandin E_(2)(PGE_(2)),the levels of oxidative stress,and inflammatory cytokine expression levels in the rats were analyzed.The experimental results showed that multiple ulcers appeared on the gastric surface of the rats in the model group.Compared to the model group,TH-GL significantly alleviated gastric ulcers and reduced the gastric damage index in rats.In addition,TH-GL significantly promoted the expression of constitutive enzyme COX-1 while inhibited the expression of inducible enzyme COX-2,and make PGE2 maintain at normal levels.TH-GL also inhibited oxidative stress and inflammatory responses,increased superoxide dismutase(SOD)activity and glutathione(GSH)content,decreased the level of malondialdehyde(MDA)and the content of pro-inflammatory factor.In conclusion,these results suggested that TH-GL could maintain the expression levels of COX-1 and PGE2 while inhibit the expression of COX-2 in the gastric of rat and then prevent IDM-induced gastric ulcer,which may be related to the regulation of oxidative stress and inflammatory response.Therefore,TH-GL might be a new option for the prevention of gastric diseases induced by IDM.

Infection control and prevention in burn victims:The role of nurses

Burn injury is a major public health concern,with an estimated 180,000 deaths each year associated with burn-related infections.The majority of these occur in low-and middle-income countries,and almost two-thirds occur in the World Health Organization African and South-East Asia Regions.There is a risk of an escalation of burn injury site infections if nurses who are directly involved in burn care do not develop a mechanism to mitigate this risk in the coming years.Hence,this study aims at explaining what burn injuries are and how nurses can prevent the occurrence of infection among burn victims.This review analyzed published studies using keywords such as burn injury,infection in burn patients,and nurses’involvement in infection prevention and control(IPC)on search engines such as PubMed,Science Direct,and Google Scholar.The literature was retrieved and reviewed for eligibility to capture just the variables indicated in this seminar objective;the date range chosen in the literature search was from 2015 to 2023.The study found that many patients die from burn injuries as a result of exposure to infection and most nurses are not adequately informed about infection control.The study also found that nurses’responsibilities include proper hand hygiene,wound care,the use of personal protective equipment,antibiotic medication,cleaning the patient’s surroundings,and preventing patient cross-contamination.Burn injuries pose a significant risk to patients,necessitating infection control and prevention.Therefore,nurses in burn units should be informed on IPC practices and also educate patients,families,and coworkers on their importance.

Basal defense is enhanced in a wheat cultivar resistant to Fusarium head blight

Fusarium head blight(FHB),mainly caused by the fungal pathogen Fusarium graminearum,is one of the most destructive wheat diseases.Besides directly affecting the yield,the mycotoxin residing in the kernel greatly threatens the health of humans and livestock.Xinong 979(XN979)is a widely cultivated wheat elite with high yield and FHB resistance.However,its resistance mechanism remains unclear.In this study,we studied the expression of genes involved in plant defense in XN979 by comparative transcriptomics.We found that the FHB resistance in XN979 consists of two lines of defense.The first line of defense,which is constitutive,is knitted via the enhanced basal expression of lignin and jasmonic acid(JA)biosynthesis genes.The second line of defense,which is induced upon F.graminearum infection,is contributed by the limited suppression of photosynthesis and the struggle of biotic stress-responding genes.Meanwhile,the effective defense in XN979 leads to an inhibition of fungal gene expression,especially in the early infection stage.The formation of the FHB resistance in XN979 may coincide with the breeding strategies,such as selecting high grain yield and lodging resistance traits.This study will facilitate our understanding of wheat-F.graminearum interaction and is insightful for breeding FHB-resistant wheat.

YOLO-MFD:Remote Sensing Image Object Detection with Multi-Scale Fusion Dynamic Head

Remote sensing imagery,due to its high altitude,presents inherent challenges characterized by multiple scales,limited target areas,and intricate backgrounds.These inherent traits often lead to increased miss and false detection rates when applying object recognition algorithms tailored for remote sensing imagery.Additionally,these complexities contribute to inaccuracies in target localization and hinder precise target categorization.This paper addresses these challenges by proposing a solution:The YOLO-MFD model(YOLO-MFD:Remote Sensing Image Object Detection withMulti-scale Fusion Dynamic Head).Before presenting our method,we delve into the prevalent issues faced in remote sensing imagery analysis.Specifically,we emphasize the struggles of existing object recognition algorithms in comprehensively capturing critical image features amidst varying scales and complex backgrounds.To resolve these issues,we introduce a novel approach.First,we propose the implementation of a lightweight multi-scale module called CEF.This module significantly improves the model’s ability to comprehensively capture important image features by merging multi-scale feature information.It effectively addresses the issues of missed detection and mistaken alarms that are common in remote sensing imagery.Second,an additional layer of small target detection heads is added,and a residual link is established with the higher-level feature extraction module in the backbone section.This allows the model to incorporate shallower information,significantly improving the accuracy of target localization in remotely sensed images.Finally,a dynamic head attentionmechanism is introduced.This allows themodel to exhibit greater flexibility and accuracy in recognizing shapes and targets of different sizes.Consequently,the precision of object detection is significantly improved.The trial results show that the YOLO-MFD model shows improvements of 6.3%,3.5%,and 2.5%over the original YOLOv8 model in Precision,map@0.5 and map@0.5:0.95,separately.These results illustrate the clear advantages of the method.

A Survey of Digital Content Required for STD Prevention Education Taught by School Nurses

Purpose: In recent years, there has been concern in Japan about the increase in STDs among adolescents aged 15 - 19. In order to prevent STDs and guide adolescents toward desirable sexual behavior, this study’s goal was to examine the actual state of STD prevention education taught by school nurses as part of the school curriculum, as well as the kinds of digital content they wish to have for teaching on the subject. Method: An anonymous, self-administered questionnaire was distributed by email and leaflet. Targeting the 100 valid responses received from the surveyed school nurses, descriptive statistics were made for each survey item and comparisons were made between the early- and mid-career groups based on years of experience. Results: 70.0% of respondents reported teaching about STDs in Health & Physical Education classes. School nurses in the early-career group used ready-made materials, while the mid-career group used both ready-made and self-made materials. 95% of respondents reported that they had little or no knowledge of STDs, while 84% reported that they were “good” or “fairly good” at teaching classes on sexuality. Both groups reported difficulty with the topics of “phimosis” and “nocturnal emissions” in the physiological category, “sexual behavior” in the “sex-adjacent” category, and “sexual and reproductive issues” in the psychosocial category. Respondents expressed a need for digital content covering the topics of “sexual violence”, “sexual abuse”, “sexually transmitted diseases”, and “how to turn down sex”. The mid-career group desired digital content for more items than the early-career group, with significant differences in the pathogens involved in sexually transmitted diseases and sex-adjacent items. 32.0% of respondents answered that they had done self-study for sex education classes in the past three years, and both groups desired self-study on “sexually transmitted diseases”, with the mid-career group significantly higher than the early-career group on “cervical cancer & HPV”, “emergency contraceptives”, and “media literacy”. Conclusion: Health & Physical Education is the main subject that covers STDs, and pre-existing materials are commonly used. It is expected that this is due to nurses’ busy schedules and the fact that only one school nurse is assigned to each school. The data collected suggested that nurse teachers want categorized digital content that can be used in the classes they are responsible for, rather than educational content on topics they are not comfortable with. In addition, given the changing environment surrounding sex, it was clear that they wish to understand the realities and needs of the high school students they teach, and desire self-study opportunities to improve their teaching methods.

Bilateral Avascular Necrosis of the Femoral Head in Renal Transplant Recipient: A Case Report

Osteoarticular complications are common after renal transplantation. The complications may result from the bone condition prior to transplantation or the iatrogenic effects of the treatments administered. These complications lead to significant morbidity and mortality, in addition to chronic pain and functional impairment. We report the clinical case of bilateral avascular necrosis (AVN) of the femoral head in a kidney transplant recipient. Clinical Case: 53-year-old male with a history of chronic hypertension. He underwent chronic hemodialysis for 12 months and was treated with Entecavir for chronic hepatitis B. The patient received a kidney transplant from a non-related living donor. Induction therapy included Thymoglobulin along with tapered corticosteroids, reaching a dose of 5 mg/day after 3 months, Mycophenolate mofetil (2 g/day), and Tacrolimus adjusted based on residual levels. There was good recovery of renal graft function. After six months, the patient reported bilateral hip pain and functional impairment of both lower limbs. Pelvic X-rays showed signs suggestive of bilateral AVN of the femoral heads. The diagnosis was confirmed by MRI. The patient underwent right hip drilling and total left hip replacement (THR). A right THR was performed a year later. Conclusion: AVN constitutes a frequent cause of morbidity and mortality after RT. The pathophysiology of osteonecrosis remains complex and multifactorial. We emphasize the importance of conducting a thorough assessment of bone health in patients both before and after RT.