MicroRNAs signatures, bioinformatics analysis of miRNAs, miRNA mimics and antagonists, and miRNA therapeutics in osteosarcoma.

MicroRNAs (miRNAs) involved in key signaling pathways and aggressive phenotypes of osteosarcoma (OS) was discussed, including PI3K/AKT/MTOR, MTOR AND RAF-1 signaling, tumor suppressor P53- linked miRNAs, NOTCH- related miRNAs, miRNA -15/16 cluster, apoptosis related miRNAs, invasion-metastasis-related miRNAs, and 14Q32-associated miRNAs cluster. Herrin, we discussed insights into the targeted therapies including miRNAs (i.e., tumor-suppressive miRNAs and oncomiRNAs). Using bioinformatics tools, the interaction network of all OS-associated miRNAs and their targets was also depicted.

Novel molecular insights and new therapeutic strategies in osteosarcoma.

Osteosarcoma (OS) is one of the most prevalent malignant cancers with lower survival and poor overall prognosis mainly in children and adolescents. Identifying the molecular mechanisms and OS stem cells (OSCs) as new concepts involved in disease pathogenesis and progression may potentially lead to new therapeutic targets. Therefore, therapeutic targeting of OSCs can be one of the most important and effective strategies for the treatment of OS. This review describes the new molecular targets of OS as well as novel therapeutic approaches in the design of future investigations and treatment.

Evaluation of Patellar Position before and After Medial Opening Wedge High Tibial Osteotomy: Radiographic and Computed Tomography Findings.

INTRODUCTION: Genovarum is a common orthopedic problem. Its optimal prompt treatment is an issue of importance. AIM: This study was conducted to determine the radiographic changes in patella bone before and after open wedge high tibial osteotomy. MATERIAL AND METHODS: In this quasi-experimental study, 43 patients were enrolled and underwent open wedge high tibial osteotomy and the radiographic and CT-scan indices including Q-Angle, Congruence Angle, Insall-Salvati index, and TTTG were measured and compared before and after surgery. RESULTS: The result revealed that all indices including Q-Angle, Congruence Angle, Insull-Salvati index, and TTTG were not significantly differed across the study (P > 0.05). There was no difference between DLFA values before and after the operation (P> 0.05), while MPTA values were significantly different before and after operation (p <0.001). CONCLUSIONS: Totally it may be concluded that imaging indices are not differed after open wedge high tibial osteotomy and monitoring for them is not necessary and they would have no prognostic role.

Evaluation of the Etiologies of Implant Fracture in Patients With Fractures of the Implants of Lower Limbs' Long Bones.

BACKGROUND: Orthopedics implants are important tools for treatment of bone fractures. Despite available recommendations for designing and making the implants, there are multiple cases of fracture of these implants in the body. Hence, in this study the frequency of failure of implants in long bones of lower extremities was evaluated. METHODS AND MATERIALS: In this cross-sectional study, two types of fractured implants in the body were analyzed and underwent metalogical, mechanical, and modeling and stress-bending analysis. RESULTS: The results revealed that the main cause of fractures was decreased mechanical resistance due to inappropriate chemical composition (especially decreased percentages of Nickel and Molybdenum). CONCLUSIONS: It may be concluded that following the standard chemical composition and use of optimal making method are the most important works for prevention of failure of implants.

Prevalence of Hepatitis B virus, Hepatitis C virus and human immunodeficiency virus infections among patients candidate for orthopedic trauma surgeries.

BACKGROUND: Infectious diseases are major public health problems, among which blood-borne ones are the most important infections. Patients who undergo orthopedic surgery are at higher risk of transmitting infectious diseases from and to others, due to repeated blood examinations and injection, drains secretion and receiving blood products. Accordingly, in this study we determined prevalence of Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) and human immunodeficiency Virus (HIV) infections in patients who underwent surgery in a general training hospital. METHODS: In this cross-sectional study the prevalence of HBV, HCV, and HIV infections was determined among 320 patients under orthopedic trauma surgeries in a general training hospital in Tehran, Iran from 2009 to 2011. Associations of these rates with age, gender, marital status, residence location, substance abuse history, hospital admission history, previous surgery, blood transfusion, dentistry procedures, and previous medical history were also assessed. RESULTS: A total of 320 patients (290 male, 30 female) were studied. Ten patients (3.2%) had at least one of these three infections. Totally 10 patients (3.2%), 2 subjects (0.6%), and 8 patients (2.5%) had HCV, HIV, and HBV infections, respectively. None of the evaluated variables had significant relationship with HCV, HBV, and HIV infections (p> 0.05). CONCLUSION: According to the obtained results, routine use of diagnostic tests for infectious disease such as HIV and viral hepatitis is recommended and should be considered before orthopedic operations.

Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries.

The aim of this study is to develop a digital monitoring system to track weight and evaluate its impact on postoperative outcomes after lower extremity surgeries (LES). This parallel randomized controlled trial enrolled 266 patients who underwent LES (fracture or joint replacement) at our medical center between March 11, 2022, and January 10, 2023. Patients were randomly assigned to the intervention and control groups in a 1:1 ratio. The intervention group (n=116) used a cane and shoes equipped with a weight-bearing system after lower limb surgery, while the control group (n=116) used a simple cane and shoes without a weight-bearing system. The primary outcomes included callus formation, duration of union, and success rate of union in the two groups. The intervention group had a significantly higher rate of complete surgical success than the control group (93.9% vs. 79.3%, p=0.001). The intervention group also had a significantly lower risk of non-union than the control group (OR: 2.33, 95% CI: 1.14, 3.48, p=0.001). The mean duration of surgery until the time of union and the meantime of callus formation was significantly lower in the intervention group (p=0.01). The use of a digital monitoring system for weighing in LES significantly increased the success rate and reduced post-operative complications. Therefore, incorporating this system can enhance the rehabilitation process and prevent revision surgeries in patients with LES.

Characteristic Features and Outcomes of Open Gunshot Fractures of Long-bones with Gustilo Grade 3: A Retrospective Study.

Background: The incidence of gunshot injuries is growing, and civilian orthopedics should be more aware of the treatment and consequences of these injuries. This study aimed to describe the characteristic features and complications of gunshot injuries to long-bones. Methods: A total of 50 patients who presented with an open gunshot fracture of the tibia, humerus, and femur in the emergency room of our hospital were included in this study. Primary irrigation and debridement, as well as prophylactic antibiotics, were administered in the emergency room. The treatment was performed either conservatively (n=4) or surgically (n=46). The external fixator, nailing, or plating was used for surgical fixation. Results: The mean age and follow-up duration of the patients were 32.3±9.9 years and 13.1±5.6 months, respectively. The most common injured long bone was the femur (32 of 50). Regarding the Gustilo grade, IIIa, IIIb, and IIIc were observed in 37, 7, and 5 patients, respectively. The Masquelet technique was used for 7 (14%) patients, and 12 (24%) cases had skin flaps. Furthermore, the vascular injury was present in 5 (10%) patients, and Malunion of the fracture site was observed in 5 (10%) cases. Nonunion of the fractured bone occurred in 13 (26%) patients that was significantly associated with the presence of vascular injuries (P=0.02). Postoperative infection occurred in 9 (18%) patients and was significantly associated with the presence of skin flap (P=0.014). Conclusion: Gunshot injuries of long bones are associated with a high incidence of post-treatment complications, such as infection and nonunion, and therefore, more intensive care should be taken to avoid these complications.

The Readability of Online Educational Materials for Femoroacetabular Impingement Syndrome.

LEVEL OF EVIDENCE: Level III.

Foot Metastasis: Review of 38 Cases.

Acrometastases are rare and account for approximately 0.1% of metastases. The most common primary cancer site is the lung, followed by colorectal and genitourinary system. We searched PubMed (www. pubmed.com), Google scholar (www.scholar.google.com), Science Direct (http://www.sciencedirect.com), and Springer (http://link.springer.com) databases, using a combination of controlled vocabulary and text word terms and reviewed the last 10 years literature in order to describe demographic trends, anatomical distribution, the most common primary sources of malignancy, and survival rates in the reports of foot metastases. In conclusion 38 cases were included in this review analysis. Lung and genitourinary system were the most frequent primary sites. Forefoot was involved in 71% of all metastases to foot either alone or in combination with other areas of the foot. Calcaneus was involved in about 23% of patients either alone or in combination with other foot bones.

Early manifestation of ARDS in COVID-19 infection in a 51- year-old man affected by Mounier-Kuhn syndrome.

A 51-year-old man known to be affected by Mounier-Kuhn syndrome (MKS). presented to Accident & Emergecy (A&E) with fever, dyspnea and deterioration of his chronic coughs. Increased diameters of his trachea (39 mm), right (30 mm) and left (26 mm) main bronchi were revealed by chest computerized tomography (CT) scan. CT scan showed also ground-glass opacities (GGO) and bronchiectasis in the mid and lower zones of both lungs. COIVD-19 infection was eventually confirmed by RT-PCR. A severe form of COVID-19 could occur even in the early stages of the disease in presence of underlying co-morbidities including MKS, which increases the susceptibility to more recurrent and severe respiratory infections.

Evaluation of inflammatory response in patients undergoing surgical treatment for early and delayed femoral fractures.

INTRODUCTION: It has been shown that long bone fractures are correlated with the inflammatory response. In the initial injury, surgical reduction and fixation of fractures induce the immunoinflammatory response. This study aimed to evaluate serum variation of inflammatory markers in patients undergoing surgical treatment for early and delayed femoral fractures. MATERIAL AND METHODS: This study aimed to evaluate serum variation of inflammatory markers in patients undergoing surgical treatment for early and delayed femoral fractures. The patients were randomly divided into two groups using the method of block randomization including early surgery (within 24 h) and delayed surgery (after 48 h). Serum levels of inflammatory markers in both groups including interleukin (IL)-1, 5, 6, tumor necrosis factor α (TNF-α) and interferon γ (IFN-γ) were determined using specific kits. From each patient 10 ml blood was collected for cytokine assay in their serum. RESULTS: Our findings suggest that serum levels of IL-8 were markedly decreased from 12 h until 48 h postoperatively (p < 0.05). Moreover, the results indicated that serum levels of TNF-α were significantly increased in the early hours, but after 48 h a decreasing trend was detected (p < 0.05). Furthermore, serum levels of IL-10, IFN-γ, and IL-6 were significantly increased from 12 h until 48 h postoperatively (p < 0.05). CONCLUSIONS: The inflammatory status of the patient may be a useful adjunct in clinical decisions. With an improved understanding of the molecular basis of the inflammatory response, and by identifying relevant clinical markers of inflammation, surgeons can better manage the timing of surgical stabilization.

Effect of high tibial osteotomy on hip biomechanics in patients with genu varum: A prospective cohort study.

BACKGROUND AND AIMS: The aim of this study is to evaluate the effect of proximal tibia osteotomy on hip biomechanics. METHODS: This cohort study was conducted on 50 knees of 37 patients divided into two groups of unilateral and bilateral surgeries during 2015-2016. Patients underwent medial open-wedge osteotomy of proximal tibia. Axial alignment of lower limb radiography was carried out for the patients before and after the osteotomy. RESULTS: Findings from unilateral and bilateral high tibial osteotomies demonstrated that the average of greater trochanter (GT) angle from femoral head center and also the average angle of knee varus were significantly decreased (P = 0.001). Although not statistically significant, the average angle of the mechanical axis of lower limb showed an increase in unilateral osteotomy (P = 0.889) and a decrease in bilateral osteotomy (P = 0.887). The average angle of pelvic obliquity after unilateral osteotomy increased significantly (P = 0.001) but showed no statistically significant difference in bilateral osteotomy (P = 0.631). CONCLUSION: High tibial osteotomy significantly affects the GT and causes the downward replacement of GT and consequent shortening of the abductors moment arm, increased hip joint reaction force, and reduction of the shear force on the femoral neck.

Diagnostic investigations of PLA2G16 and CDH11 expression levels as independent prognostic markers of human osteosarcoma.

INTRODUCTION: The aim of this study was to facilitate and deepen the understanding of the associations of the clinical significance of PLA2G16 and CDH11 in patients with osteosarcoma. MATERIAL AND METHODS: We collected 50 paired osteosarcoma tissues and adjacent normal bone tissues and evaluated the expression of PLA2G16 and CDH11 by quantitavise reverse transcriptase real-time polymerase chain reaction. RESULTS: PLA2G16 expression was upregulated in osteosarcoma tissues when compared with adjacent normal bone tissues, and the difference was statistically significant (4.78 ±0.70 vs. 1.31 ±0.65; p < 0.05). Our data indicated that high expression of PLA2G16 was significantly related to advanced TNM stage and metastasis or recurrence (p < 0.05). The expression level of CDH11 was lower in osteosarcoma tissues (median relative expression level ± SD: 6.29 ±1.43) than adjacent normal bone tissues (mean ± SD: 13.72 ±3.08, p < 0.05). Our findings demonstrated that decreased expression of CDH11 was strongly linked to advanced TNM stage, and metastasis or recurrence (p < 0.05). Log-rank analysis showed that patients with high expression of PLA2G16 have shorter overall survival than those with low expression. Moreover, shorter overall survival was significantly correlated with decreased expression of CDH11. Multivariate Cox proportional hazards analysis showed that PLA2G16 (p = 0.028; HR = 2.621; 95% CI) and CDH11 (p = 0.023; HR = 2.81; 95% CI) expression and also metastasis or recurrence (p = 0.03; HR = 2.531; 95% CI) were independent prognostic factors for poor overall survival of osteosarcoma patients. CONCLUSIONS: These findings suggest that PLA2G16 and CDH11 expression can be independent prognostic factors for poor overall survival of patients with osteosarcoma.