Biopsia de sacro: canal de trabajo seguro mediante un sistema tubular / Sacral biopsy: safe working channel by tubular system

No existe un protocolo estandarizado para la toma de biopsias en el sacro. El cirujano, según su experiencia y la sospecha diagnóstica es quien elige el método y la técnica. Se necesita una planificación prequirúrgica para evitar comprometer el sitio de abordaje y disminuir las complicaciones de la técnica, como una muestra insuficiente, daño neurovascular o siembra tumoral. El objetivo de este artículo es comunicar nuestra experiencia en la toma de biopsia con una técnica mínimamente invasiva utilizando un sistema tubular en un tumor de sacro. Presentamos a una mujer de 34 años con sospecha de un tumor primario de sacro (tumor de células gigantes y cordoma principalmente), se planifica el abordaje y se crea un canal de trabajo seguro mediante un sistema tubular y se toman muestras con aguja gruesa guiada por radioscopia. Conclusión:La toma de biopsia ósea ayudada de un sistema tubular para crear un trayecto seguro es una alternativa para tener en cuenta ante la sospecha de tumores con riesgo de siembra. Nivel de Evidencia: IV

There is no standardized protocol for sacral biopsies, the choice of method and technique depends on the surgeon based on their experience and diagnostic suspicion. Preoperative planning is necessary to preserve the approach site and reduce complications of the technique such as insufficient specimen, neurovascular damage, or tumor seeding. The aim of our work is to present our experience performing a sacral tumor biopsy with a minimally invasive technique using a tubular system. We present a 34-year-old female patient with suspected primary sacral tumor (mainly giant cell tumor and chordoma). The approach for a fluoroscopy-guided core needle biopsy was planned, and a safe working channel was created using a tubular system. Conclusion: Bone biopsy, assisted by a tubular system to create a safe channel, is an option to consider in the case of suspected tumors at risk of seeding. Level of Evidence: IV

Pérdida de stock óseo no osteoporótico en la columna. Denosumab como herramienta de tratamiento e implicancia / Non-osteoporotic loss of spinal bone. Denosumab as a therapeutic tool and its implications

Introducción: El denosumab es un anticuerpo monoclonal humano que actúa contra el RANKL, inhibiendo la destrucción ósea mediada por los osteoclastos, así evitando la pérdida de stock óseo; por este motivo, se lo utiliza en el tratamiento de la osteoporosis como agente antiresortivo y está autorizado para el tratamiento del tumor de células gigantes y el mieloma múltiple. Nuestro objetivo fue conocer las indicaciones y contraindicaciones para la pérdida de stock óseo de causa no osteoporótica. Materiales y métodos: Revisión sistemática de artículos en inglés publicados en el período 2009-2023. Se incluyeron artículos que indicaran o contraindicaran el uso del denosumab. Resultados: De un total inicial de 4306 artículos, se analizaron 18 artículos que mostraban consenso en la dosis y los controles con tomografía e indicaban o contraindicaban el uso del denosumab. Conclusiones: El denosumab está indicado como una buena opción de tratamiento preferente de tumores vertebrales primarios inoperables, para evitar recidivas o demorar las metástasis de tumores primarios o de tumores sólidos, principalmente de mama, próstata y pulmón, y para el compromiso vertebral del mieloma múltiple. El denosumab está contraindicado, por el momento, para las lesiones infecciosas. Nivel de Evidencia: III

Background: Denosumab is a human monoclonal antibody that acts against RANKL, inhibiting bone destruction mediated by osteoclasts, thus avoiding bone loss. For this reason, it is used in the treatment of osteoporosis as an antiresorptive and is authorized for the treatment of giant cell tumor and multiple myeloma. Our objective is to understand its indications and contraindications for the treatment of non-osteoporotic bone loss. materials and methods: A systematic review of English-language articles published between 2009 and 2023, using PRISMA criteria. Articles indicating or contraindicating the use of denosumab were considered for inclusion. Results: From a total of 4306 articles, 18 articles were analyzed, which showed consensus on the dose and controls with tomography and indicated or contraindicated the use of denosumab. Conclusions: Denosumab is recommended as a primary therapeutic option for unresectable spinal tumors, to prevent recurrences or to delay the formation of metastases from primary tumors or solid tumors, primarily breast, prostate, and lung, as well as for multiple myeloma spinal involvement. Denosumab is currently contraindicated in infectious lesions. Level of Evidence: III

Osteocondroma de calcáneo solitario con crecimiento después de la madurez esquelética. Reporte de un caso y revisión bibliográfica / Solitary calcaneal osteochondroma with growth after skeletal maturity. Case report and literature review

El osteocondroma es el tumor óseo benigno más frecuente, representa el 35% de los tumores óseos benignos y el 8% de los tumores óseos. Está formado por una exostosis de hueso trabecular recubierta de cartílago que afecta la región metafisaria de los huesos largos, a partir del cartílago de crecimiento, alrededor de la rodilla, en el hombro o la muñeca, y es extremadamente raro en las falanges de la mano o el pie. Crece durante la niñez y la adolescencia hasta alcanzar la madurez esquelética; por lo tanto, su crecimiento en un adulto sugiere la transformación maligna en condrosarcoma, aunque también existen reportes sin malignización. Además, el calcáneo es un hueso corto, por lo que, desde el punto de vista fisiopatológico, sería inesperada la aparición de este tipo de lesión. El objetivo de este artículo es presentar un caso de osteocondroma de calcáneo solitario con crecimiento después de la madurez esquelética, su diagnóstico y tratamiento, así como una revisión bibliográfica. Esta presentación de caso es importante, dados la localización infrecuente y el potencial de transformación maligna del osteocondroma, y la escasa bibliografía sobre el tema. Nivel de Evidencia: IV

Osteochondroma is the most common benign bone tumor, accounting for 35% of benign bone tumors and 8% of bone tumors. It is formed by an exostosis of trabecular bone covered with cartilage that affects the metaphyseal region of long bones, from the growth plate, around the knee, in the shoulder or wrist, and it is extremely rare in the phalanges of the hand or foot. It grows during childhood and adolescence until skeletal maturity. Therefore, its growth in an adult suggests a malignant transformation into chondrosarcoma, although there are also reports without malignancy. Furthermore, the calcaneus is a short bone, so the appearance of this type of injury would be pathophysiologically unexpected. Our objective is to present a case of solitary calcaneal osteochondroma with growth after skeletal maturity, its diagnosis and treatment, as well as a review of the literature. Its relevance stems from the scarcity of literature, its uncommon location, and the possibility of malignancy. Level of Evidence: IV

Comparative study of orthopaedic robot-assisted minimally invasive surgery and open surgery for limb osteoid osteoma / 中国修复重建外科杂志

OBJECTIVE@#To compare the accuracy and effectiveness of orthopaedic robot-assisted minimally invasive surgery versus open surgery for limb osteoid osteoma.@*METHODS@#A clinical data of 36 patients with limb osteoid osteomas admitted between June 2016 and June 2023 was retrospectively analyzed. Among them, 16 patients underwent orthopaedic robot-assisted minimally invasive surgery (robot-assisted surgery group), and 20 patients underwent tumor resection after lotcated by C-arm X-ray fluoroscopy (open surgery group). There was no significant difference between the two groups in the gender, age, lesion site, tumor nidus diameter, and preoperative pain visual analogue scale (VAS) scores ( P>0.05). The operation time, lesion resection time, intraoperative blood loss, intraoperative fluoroscopy frequency, lesion resection accuracy, and postoperative analgesic use frequency were recorded and compared between the two groups. The VAS scores for pain severity were compared preoperatively and at 3 days and 3 months postoperatively.@*RESULTS@#Compared with the open surgery group, the robot-assisted surgery group had a longer operation time, less intraoperative blood loss, less fluoroscopy frequency, less postoperative analgesic use frequency, and higher lesion resection accuracy ( P<0.05). There was no significant difference in lesion resection time ( P>0.05). All patients were followed up after surgery, with a follow-up period of 3-24 months (median, 12 months) in the two groups. No postoperative complication such as wound infection or fracture occurred in either group during follow-up. No tumor recurrence was observed during follow-up. The VAS scores significantly improved in both groups at 3 days and 3 months after surgery when compared with preoperative value ( P<0.05). The VAS score at 3 days after surgery was significantly lower in robot-assisted surgery group than that in open surgery group ( P<0.05). However, there was no significant difference in VAS scores at 3 months between the two groups ( P>0.05).@*CONCLUSION@#Compared with open surgery, robot-assisted resection of limb osteoid osteomas has longer operation time, but the accuracy of lesion resection improve, intraoperative blood loss reduce, and early postoperative pain is lighter. It has the advantages of precision and minimally invasive surgery.

Uso de imágenes KV CBCT del acelerador lineal Halcyon para la planificación de tratamientos de metástasis óseas con intensión paliativa / Use of KV CBCT images from the Halcyon linear accelerator for treatment planning of bone metastases with palliative intent

Las nuevas tecnologías para el tratamiento del cáncer con radiación ionizante tienen especial interés en mejorar la calidad de las imágenes para el posicionamiento adecuado del paciente con sistemas de radioterapia guiada por imagen IGRT. El sistema Halcyon cuenta con imágenes de tomografía computarizada de haz de cono CBCT. Estas imágenes podrían ser una opción para escenarios donde no se cuente con una Tomografía Computarizada CT o el equipo se encuentre en reparación o mantenimiento especialmente para escenarios de intensión paliativa. La diferencia en la distribución de dosis en imágenes CT y CBCT fue analizada en este estudio. Los resultados mostraron diferencias en las unidades Hounsfield UH, aunque no fueron estadísticamente significativas, el volumen irradiado mostro diferencias máximas de 3,92% que no supera el 4% permitido para tratamientos de intensión paliativa. En cuanto a las dosis dispersas al tejido sano la diferencia tampoco supera el 4%. Nuestro estudio mostro que las imágenes CBCT pueden ser una alternativa para el tratamiento de metástasis óseas, sin embargo, estas imágenes todavía no pueden remplazar las imágenes CT utilizadas para el cálculo de dosis en radioterapia

New technologies for the treatment of cancer with ionizing radiation are of particular interest in improving image quality for proper patient positioning with image-guided radiation therapy IGRT systems. IGRT image-guided radiation therapy systems. The Halcyon system features cone beam computed tomography CBCT imaging. These images could be an option for scenarios where a CT scan is not available or the equipment is under repair or maintenance especially for is under repair or maintenance, especially for palliative scenarios. The difference in the The difference in dose distribution in CT and CBCT images was analyzed in this study. The results showed differences in Hounsfield UH units, although not statistically significant, the irradiated volume showed maximum differences of 3.92%, which is the maximum difference of 3.92%. Differences of 3.92%, which does not exceed the 4% allowed for palliative treatments. As for the doses dispersed to healthy tissue the difference does not exceed the 4% allowed for palliative treatments. Our study showed that CBCT imaging can be an alternative for the treatment of metastases. an alternative for the treatment of bone metastases, however, these images cannot yet replace the CT images used for dose calculation. CT images used for dose calculation in radiotherapy

Schwannoma intraóseo en fémur, una presentación inusual. Reporte de caso / Intraosseous Schwannoma in femur, an unusual presentation. Case report

El Schwannoma o Neurilemoma es un tumor benigno de derivación neuroectodérmica que se origina en las células de Schwann, que constituyen la envoltura de los nervios. Es el tumor benigno más común de los nervios periféricos, tiene predisposición a originarse a partir de nervios periféricos sensoriales y puede presentarse como tumores en tejidos blandos. La presentación intraósea del Schwannoma es rara y corresponde al 0,2% de los tumores óseos primarios. Se presenta caso clínico de paciente masculino de 36 años de edad con tumor en cóndilo femoral medial de rodilla derecha de 4 años de evolución, cursando con dolor intermitente moderado a quien se le practicó el protocolo oncológico, imagenológico e histológico, de la Unidad de Oncología Ortopédica del estado Monagas. Se diagnosticó Schwannoma intraóseo, se procedió a realizar resección marginal y reconstrucción con alloinjerto y fijación con placa y tornillos con excelente evolución postoperatoria. El Schwannoma intraóseo es extraordinariamente raro y su ubicación en el fémur lo es aún más. El objetivo del presente trabajo es reportar un caso de Schwannoma Intraóseo, mostrar las estrategias para su diagnóstico y los tratamientos aplicados, así como la revisión de los datos al respecto existentes en la literatura(AU)

Schwannoma or Neurilemoma is a benign tumor of neuroectodermal derivation that originates in Schwann cells, which constitute the nerve sheath. It is the most common benign tumor of the peripheral nerves, has a predisposition to originate from peripheral sensory nerves, and can present as soft tissue tumors. The intraosseous presentation of Schwannoma is rare and corresponds to 0,2% of primary bone tumors. A clinical case of a 36-yearold male patient with a tumor in the medial femoral condyle of the right knee of 4 years of evolution is presented, presenting with moderate intermittent pain who underwent the oncological, imaging and histological protocol of the Oncology Unit. Monagas State Orthopedic. Intraosseous Schwannoma was diagnosed, marginal resection and allograft reconstruction and plate and screw fixation were performed with excellent postoperative evolution. Intraosseous Schwannoma is extraordinarily rare and its location in the femur is even more so. The objective of this paper is to report a case of Intraosseous Schwannoma, show the strategies for its diagnosis and the treatments applied, as well as the review of the existing data in the literature(AU)

Bone involvement in non-congenital syphilis / Compromiso óseo por sífilis no congénita

We documented two stages of bone involvement due to syphilis in two adult patients infected with human immunodeficiency virus. Bony lesions of secondary versus tertiary syphilis cannot be differentiated on clinical or radiologic grounds alone. Given the rarity of this clinical presentation, there is no consensus on treatment duration and related outcomes.

Se describen dos etapas de compromiso óseo por sífilis en dos pacientes adultos infectados por el virus de la inmunodeficiencia humana. Las lesiones óseas de la sífilis secundaria y de la sífilis terciaria no se pueden diferenciar únicamente por características clínicas o radiológicas. Dada la rareza de esta presentación clínica, no hay consenso sobre la duración del tratamiento y los resultados relacionados.

Sarcoma de Ewing multifocal: presentación de un caso pediátrico / Multifocal Ewing sarcoma: presentation of a pediatric case / Sarcoma de Ewing Multifocal: apresentação de um caso pediátrico

Introducción: el Sarcoma de Ewing es una neoplasia maligna de origen mesenquimático. Al momento del diagnóstico el 75% se presentan en forma localizada. Objetivo: comunicar un caso que por su presentación multifocal, generó dificultades diagnósticas. Caso clínico: niña de 6 años. Consulta por traumatismo de mano derecha tras caída de su altura 24 horas previas, constatándose en mano y puño derecho edema, calor y eritema, movilidad conservada. No fiebre. Radiografía: aumento del diámetro del tercer metacarpiano, imagen esmerilada, no trazos de fracturas. Ingresa con planteo de celulitis. Anemia leve microcítica, hipocrómica. Proteína C reactiva 82 mg/l. Recibe clindamicina intravenosa 72 horas, completa 14 días vía oral. Persistencia de alteraciones en puño y mano derecha, agrega tumoración de raíz nasal con desviación del eje, indolora. Fosfatasa alcalina, lactato deshidrogenasa, fosfatemia, calcemia normales. Resonancia magnética: alteración morfoestructural de radio, olecranon y tercer metacarpiano, fractura de olecranon y radio, reacción perióstica. Pet-Scan: lesión extensa ósea en macizo facial, tibias, cúbitos, humero derecho y clavícula. Biopsia 3er metacarpiano: tumor de células pequeñas, redondas azules, CD99 y vimentina positivo. Comienza poliquimioterapia y radioterapia sin complicaciones. Conclusiones: es frecuente que las manifestaciones clínicas iniciales sean confundidas con entidades más frecuentes, como post-traumáticas y/o inflamatorias, tal como ocurrió en este caso. Posteriormente, la aparición de nuevas lesiones y compromiso del estado general orientó el abordaje diagnóstico de la patología tumoral. La confirmación exige el estudio anatomopatológico con estudio inmunohistoquímico. La presencia de metástasis óseas constituye un factor de mal pronóstico y dificulta el abordaje terapéutico.

Introduction: Ewing's sarcoma is a malignant neoplasm of mesenchymal origin. At the time of diagnosis 75% of the cases are localized. Objective: to report a case that, due to its multifocal presentation, generated diagnostic difficulties. Clinical case: 6-year-old girl. She consulted for right hand trauma after a fall from her height 24 hours earlier, with edema, warmth and erythema in the right hand and fist, with preserved mobility. No fever. X-ray: increase in the diameter of the 3rd metacarpal, frosted image, no traces of fractures. Admitted with cellulitis. Mild microcytic anemia, hypochromic. C-reactive protein 82mg/l. Receives intravenous clindamycin 72 hours, completes 14 days orally. Persistence of alterations in fist and right hand, adds tumor of nasal root with deviation of the axis, painless. Alkaline phosphatase, lactate dehydrogenase, phosphatemia, normal calcemia. MRI: morphostructural alteration of radius, olecranon and 3rd metacarpal, fracture of olecranon and radius, periosteal reaction. Pet-Scan: extensive bone lesion in facial mass, tibiae, ulnae, right humerus and clavicle. Biopsy 3rd metacarpal: small cell tumor, blue round, CD 99 and vimentin positive. Polychemotherapy and radiotherapy were started without complications. Conclusions: it is frequent that the initial clinical manifestations are confused with more frequent entities, such as post-traumatic and/or inflammatory, as occurred in this case. Subsequently, the appearance of new lesions and compromise of the general condition guided the diagnostic approach of the tumor pathology. Confirmation requires anatomopathological study with immunohistochemical study. The presence of bone metastases constitutes a poor prognostic factor and hinders the therapeutic approach.

Introdução: O sarcoma de Ewing é um neoplasma maligno de origem mesenquimatosa. No momento do diagnóstico, 75% dos casos são localizados. Objetivo: Relatar um caso que, devido a sua apresentação multifocal, causou dificuldades diagnósticas. Caso clínico: Menina de 6 anos. Ela consultou por traumatismo à mão direita após cair de sua altura 24 horas antes, com edema, calor e eritema na mão direita e punho, com mobilidade preservada. Sem febre. Raio-X: aumento do diâmetro do 3º metacarpo, imagem fosca, sem vestígios de fraturas. Admitido com a sugestão de celulite. Anemia microcítica leve, hipocrómica. Proteína C reativa 82mg/l. Recebe clindamicina intravenosa por 72 horas, completa 14 dias por via oral. Persistência de alterações no punho e mão direita, tumor indolor da raiz nasal com desvio do eixo. Fosfatase alcalina, desidrogenase láctica, fosfataemia, calcemia normal. IRM: alteração morfo-estrutural do rádio, olecrânio e 3º metacarpo, fratura do olecrânio e do rádio, reação periosteal. Pet-Scan: extensa lesão óssea na massa facial, tíbia, ulnae, úmero direito e clavícula. Biópsia do 3º metacarpo: tumor de pequenas células, redondo azul, CD 99 e vimentina positiva. Ela iniciou a poli-quimioterapia e radioterapia sem complicações. Conclusões: É comum que as manifestações clínicas iniciais sejam confundidas com entidades mais freqüentes, tais como pós-traumáticas e/ou inflamatórias, como ocorreu neste caso. Posteriormente, o aparecimento de novas lesões e o envolvimento do quadro geral levaram a uma abordagem diagnóstica da patologia tumoral. A confirmação requer um estudo anatomopatológico com estudo imuno-histoquímico. A presença de metástases ósseas é um fator de mau prognóstico e dificulta a abordagem terapêutica.

Argon Beam Coagulation as an Adjuvant for Extended Curettage for Giant Cell Tumors of the Bone: A Study of 50 Cases / Coagulação por plasma de argônio como adjuvante à curetagem estendida em tumores de células gigantes do osso: Um estudo de 50 casos

Abstract Objective Extended curettage with adjuvants of giant cell tumors of bone is associated with a lower rate of recurrence of the tumor while preserving the adjacent joint. The present study was conducted to estimate the recurrence rate and functional outcome after using argon beam as an adjuvant for extended curettage. Methods We selected 50 patients with giant cell tumors, meeting all the inclusion criteria, who underwent extended curettage using high speed burr and argon beam photocoagulation between July 2016 to January 2019. On their follow-up visit, they were assessed for any complaints of pain and signs like tenderness, locally raised temperature, and decreased range of motion of the adjacent joint. Radiologically, the patients were assessed for any increased lucency around the cement mantle and uptake of the subarticular graft. Musculoskeletal Tumor Society Score (MSTS) was administered to the patients, and range of motion of the adjacent joint was compared with the contralateral joint. Results Recurrence was found in 4 patients, that is, an 8% recurrence rate. Twenty-six out of 28 patients with a tumor in the lower limb had a grade-5 weight bearing status 6 months from the surgery, and their range of motion was comparable to contralateral healthy joint with an average MSTS score of 27 (18-30). Conclusion Extended curettage of giant cell tumors using argon beam coagulation is associated with low recurrence rates of the tumor and is an effective modality in the treatment of these tumors besides having a functional outcome comparable to the healthy limb.

Resumo Objetivo A curetagem estendida com adjuvantes de tumores de células gigantes do osso está associada a uma menor taxa de recidiva da neoplasia e à preservação da articulação adjacente. Este estudo foi feito para estimar a taxa de recidiva e o resultado funcional após o uso de plasma de argônio como adjuvante à curetagem estendida. Métodos Cinquenta pacientes com tumores de células gigantes que atendiam a todos os critérios de inclusão foram selecionados para o estudo e submetidos à curetagem estendida com broca de alta velocidade e fotocoagulação com plasma de argônio entre julho de 2016 e janeiro de 2019. À consulta de acompanhamento, os pacientes foram avaliados quanto a quaisquer queixas de dor e sinais como sensibilidade, aumento local da temperatura e diminuição da amplitude de movimento da articulação adjacente. Radiologicamente, os pacientes foram avaliados quanto à presença de qualquer aumento de radiotransparência ao redor do manto de cimento e incorporação do enxerto subarticular. O questionário Musculoskeletal Tumor Society Score (MSTS) foi administrado aos pacientes e a amplitude de movimentação da articulação adjacente foi comparada à articulação contralateral. Resultados Quatro pacientes apresentaram recidiva, o que corresponde a uma taxa de 8%. Seis meses após a cirurgia, 26 de 28 pacientes com tumor no membro inferior tinham capacidade de sustentação de peso de grau 5 e amplitude de movimento comparável à articulação saudável contralateral, com pontuação MSTS média de 27 (intervalo de 18 a 30). Conclusão A curetagem estendida de tumores de células gigantes com coagulação por plasma de argônio está associada a baixas taxas de recidiva da neoplasia; é uma modalidade eficaz no tratamento desses tumores e o resultado funcional é comparável ao do membro saudável.

Technique for Foot Reconstruction with Custom-made Calcaneal Prosthesis in Primary Malignancy - A Case Report / Técnica de reconstrução do pé com prótese de calcâneo feita sob medida em câncer primário - Relato de caso

Abstract The foot is an uncommon location for osseous tumors, comprising ~ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Resumo O pé é um local incomum para tumores ósseos, e compreende cerca de 3% de todos os tumores esqueléticos, em especial ao redor do calcâneo. A cirurgia radical cria um vazio no pé, o que afeta de forma negativa a capacidade de resgate do membro. As cirurgias de reconstrução do calcâneo não são comumente realizadas por causa da instabilidade da prótese, defeito de partes moles, e consequente possibilidade de insucesso pósoperatório. Assim, apresentamos aqui um caso raro de sarcoma sinovial originário da bainha do tendão tibial posterior com acometimento secundário do osso calcâneo. Considerando as experiências prévias de diferentes cirurgiões, projetamos uma prótese sob medida com modificações relevantes.

Risk factors associated with surgical site infection in patients with musculoskeletal cancer / Fatores de risco associados à infecção de sítio cirúrgico em portadores de câncer musculoesquelético / Factores de riesgo asociados a la infección del sitio quirúrgico en pacientes con cáncer musculoesquelético

Background and objectives: surgical site infections (SSI) continue to be a major concern in orthopedic oncology and pose as great a challenge as cancer recurrence, despite the preventive potential of surgery. SSI can be avoided if evidence-based measures are taken. The objective was to assess the frequency of infections in oncological orthopedic surgeries and associated risk factors and inflammatory markers in a reference hospital in the state of Pernambuco. Methods: the frequency of SSI, the identification of isolated microorganisms, the risk factors and the profile of Th1 and Th2 inflammatory markers (IL-2, IL-4, IL-6, IL-10, TNF and IFN-Ƴ) in patients with musculoskeletal cancer were analyzed. Results: SSI were found in 9.1% of patients undergoing orthopedic surgery. Bivariate analysis revealed that a surgical team comprising more than five members (p=0.041) and the need for intraoperative transfusion (p=0.012) were correlated with a higher risk of SSI. The measurement of ultrasensitive C-reactive protein levels to assess the inflammatory response after SSI showed results that were superior to the reference values for each sample, ranging from >5 to >200mg/dl by the immunoturbidimetric method. Of the IL-2, INFγ and TNF (Th1) and IL-4, IL-6, IL-10 (Th2) levels, only interleukin 6 showed high levels, between 6.68 and 58.76 pg/mL. Conclusion: the study found that surgical team with five or more members and blood transfusion were factors associated with the development of SSI in orthopedic surgery in patients with musculoskeletal cancer. Among the inflammatory markers, interleukin 6 (IL-6) showed the highest correlation with the outcome.(AU)

Justificativa e objetivos: as infecções do sítio cirúrgico (ISC) continuam sendo uma grande preocupação na oncologia ortopédica e representam um desafio tão grande quanto a recorrência do câncer, apesar do potencial preventivo da cirurgia. As ISC podem ser evitadas se forem tomadas medidas baseadas em evidências. O objetivo foi avaliar a frequência de infecções em cirurgias ortopédicas oncológicas e os fatores de risco e marcadores inflamatórios associados em um hospital de referência no estado de Pernambuco. Métodos: foram analisados a frequência de ISC, a identificação de microrganismos isolados, os fatores de risco e o perfil de marcadores inflamatórios Th1 e Th2 (IL-2, IL-4, IL-6, IL-10, TNF e IFN-Ƴ) em pacientes portadores de câncer musculoesquelético. Resultados: as ISC foram encontradas em 9,1% dos pacientes submetidos à cirurgia ortopédica. A análise bivariada revelou que uma equipe cirúrgica composta por mais de cinco membros (p=0,041) e a necessidade de transfusão intraoperatória (p=0,012) foram correlacionadas com maior risco de ISC. A dosagem dos níveis de proteína C reativa ultrassensível para avaliação da resposta inflamatória após ISC apresentou resultados superiores aos valores de referência para cada amostra, variando de >5 a >200mg/dl pelo método imunoturbidimétrico. Dos níveis de IL-2, INFγ e TNF (Th1) e IL-4, IL-6, IL-10 (Th2), apenas a interleucina 6 apresentou níveis elevados, entre 6,68 e 58,76 pg/mL. Conclusão: o estudo constatou que equipe cirúrgica com cinco ou mais membros e transfusão sanguínea foram fatores associados ao desenvolvimento de ISC em cirurgia ortopédica em pacientes com câncer musculoesquelético. Entre os marcadores inflamatórios, interleucina 6 (IL-6) apresentou maior correlação com o desfecho.(AU)

Justificación y objetivos: las infecciones del sitio quirúrgico (ISQ) siguen siendo una preocupación importante en la oncología ortopédica y representan un desafío tan grande como la recurrencia del cáncer, a pesar del potencial preventivo de la cirugía. Las ISQ se pueden prevenir si se toman medidas basadas en la evidencia. El objetivo fue evaluar la frecuencia de infecciones en cirugías ortopédicas oncológicas y los factores de riesgo y marcadores inflamatorios asociados en un hospital de referencia en el estado de Pernambuco. Métodos: se analizaron la frecuencia de ISQ, la identificación de microorganismos aislados, los factores de riesgo y el perfil de marcadores inflamatorios Th1 y Th2 (IL-2, IL-4, IL-6, IL-10, TNF e IFN-Ƴ) en pacientes con cáncer musculoesquelético. Resultados: se encontraron ISQ en el 9,1% de los pacientes sometidos a cirugía ortopédica. El análisis bivariado reveló que un equipo quirúrgico compuesto por más de cinco miembros (p=0,041) y la necesidad de transfusión intraoperatoria (p=0,012) se correlacionaron con un mayor riesgo de ISQ. La medición de los niveles de proteína C reactiva ultrasensible para evaluar la respuesta inflamatoria después de la ISQ presentó resultados superiores a los valores de referencia para cada muestra, variando de >5 a >200 mg/dl por el método inmunoturbidimétrico. De los niveles de IL-2, INFγ y TNF (Th1) e IL-4, IL-6, IL-10 (Th2), solo la interleucina 6 mostró niveles elevados, entre 6,68 y 58,76 pg/mL. Conclusión: el estudio encontró que el equipo quirúrgico con cinco o más miembros y la transfusión el estudio encontró que un equipo quirúrgico con cinco o más miembros y transfusión de sangre fueron factores asociados con el desarrollo de ISQ en cirugía ortopédica en pacientes con cáncer musculoesquelético. Entre los marcadores inflamatorios, la interleucina 6 (IL-6) mostró la mayor correlación con el resultado.(AU)

Axial Axis Metastasis / Metástase do eixo axial

Abstract Axial axis metastasis remains a challenge for surgical as well as other treatment modalities, like chemotherapy, immunotherapy, and radiotherapy. It is unequivocal that surgery provides pain improvements and preservation of neurological status, but this condition remains when associated with radiotherapy and other treatment modalities. In this review, we emphasize the current forms of surgical treatment in the different regions of the spine and pelvis. The evident possibility of percutaneous treatments is related to early or late cases, and in cases in which there are greater risks and instability to conventional surgeries associated with radiotherapy and have been shown to be the appropriate option for local control of metastatic disease.

Resumo As metástases no eixo axial permanecem um desafio para o tratamento cirúrgico bem como para outras modalidades, como quimioterapia, imunoterapia e radioterapia. É inequívoco que a cirurgia proporciona melhorias na dor e na preservação do status neurológico; porém, há permanência desta condição quando associada à radioterapia e a outras modalidades de tratamento. Nesta revisão damos ênfase às formas de tratamento cirúrgico atuais nas diferentes regiões da coluna vertebral e pelve. A evidente possibilidade de tratamentos percutâneos está relacionada a casos iniciais ou tardios, bem como a casos em que há maiores riscos e instabilidade às cirurgias convencionais associadas à radioterapia, e tem se mostrado a opção adequada para o controle local da doença metastática.

Pain Assessment in Pediatric Patients with Primary Bone Cancer in a Single Site Cohort / Avaliação da Dor em Pacientes Pediátricos com Câncer Ósseo Primário em uma Coorte de um Centro Único / Evaluación del Dolor en Pacientes Pediátricos con Cáncer Óseo Primario en una Cohorte de un Solo Centro

Introduction: Pain is the main symptom described in cancer patients. Objective: To assess pain classification and management in pediatric patients with primary bone cancer over time: admission, during treatment and follow-up, and to investigate factors associated with pain classification at the last assessment. Method: Retrospective cohort study of osteosarcoma and Ewing's sarcoma cases in individuals <19 years old treated at a single cancer referral site and followed up by a multidisciplinary team. The primary endpoint was pain score at the last assessment. Secondary outcome: evolution of pharmacological treatment. Results: 142 patients were included. The frequency of pain assessment increased during the study period from 53.5% at admission to 68.3% during treatment and 85.9% in follow-up. Of the patients who had pain assessed, 65.8% had pain at admission and 26.2% at the end of the study. There was an increase in the use of strong opioids and antidepressants. In the last evaluation, 56 patients (39.4%) were at the end-of-life and this was not associated with more pain (p=0.68). Meanwhile, those who had more pain used strong opioids (p=0.01) or steroids (p=0.03). Conclusion: Pain management during treatment resulted in increased use of strong opioids and antidepressants with pain reduction, revealing that pain control is possible. In the last assessment, end-of-life patients no longer had pain and patients with pain were the ones who used strong opioids and steroids at the most, showing the difficulty of pain control in some patients.

Introdução: A dor é o principal sintoma descrito em pacientes com câncer. Objetivo: Avaliar a classificação e o manejo da dor em pacientes pediátricos com câncer ósseo primário ao longo do tempo: admissão, durante o tratamento e acompanhamento, e investigar fatores associados à classificação da dor na última avaliação. Método: Estudo de coorte retrospectivo de casos de osteossarcoma e sarcoma de Ewing em indivíduos <19 anos, atendidos em único centro de referência de câncer e acompanhados por equipe multidisciplinar. Desfecho primário: classificação da dor na última avaliação. Desfecho secundário: evolução do tratamento farmacológico. Resultados: Foram incluídos 142 pacientes. A frequência de avaliação da dor aumentou durante o período do estudo de 53,5% na admissão para 68,3% durante o tratamento, chegando a 85,9% no acompanhamento. Dos pacientes cuja dor foi avaliada, 65,8% tiveram dor no recrutamento e 26,2% ao final do estudo. Houve aumento no uso de opioides fortes e antidepressivos. Na última avaliação, 56 pacientes (39,4%) estavam no fim da vida sem associação com mais dor (p=0,68), enquanto os que apresentaram mais dor foram aqueles que usavam opioides fortes (p=0,01) ou esteroides (p=0,03). Conclusão: O manejo da dor durante o tratamento resultou em aumento do uso de opioides fortes e antidepressivos com redução da dor, revelando que o controle da dor é possível. Na última avaliação, os pacientes em fim de vida não apresentavam mais dor, e os pacientes com dor foram os que mais utilizaram opioides fortes e esteroides, evidenciando a dificuldade no controle da dor em alguns pacientes.

Introducción: El dolor es el principal síntoma descrito en pacientes oncológicos. Objetivo: Evaluar la clasificación y el manejo del dolor en pacientes pediátricos con cáncer óseo primario a lo largo del tiempo: registro, durante el tratamiento y seguimiento, e investigar los factores asociados entre la clasificación del dolor y última evaluación. Método: Estudio cohortes retrospectiva de casos de osteosarcoma y sarcoma de Ewing <19 años, tratados en único centro de referencia oncológica y seguidos por equipo multidisciplinar. Desenlace primario: calificación del dolor en la última evaluación. Desenlace secundario: evolución del tratamiento farmacológico. Resultados: Se incluyeron 142 pacientes. La frecuencia de evaluación del dolor aumentó durante el período de estudio del 53,5% al 68,3% y 85,9%. Los pacientes evaluados por dolor, el 65,8% tenía dolor al registro y 26,2% al final del estudio. Hubo aumento en el uso de opioides fuertes y antidepresivos. En la última evaluación, 56 pacientes (39,4%) estaban al final de su vida y esto no se asoció con más dolor (p=0,68), mientras que, quienes presentaron más dolor fueron quienes usaban opioides fuertes (p=0,01) o esteroides (p=0,03). Conclusión: Manejo del dolor durante el tratamiento resultó en un mayor uso de opioides fuertes y antidepresivos con reducción del dolor, revelando que es posible controlar el dolor. La última evaluación, pacientes al final de la vida ya no tenían dolor y pacientes con dolor eran los que más usaban opioides fuertes y esteroides, evidenciando la dificultad en el control del dolor en algunos pacientes.

Cordoma Sacral: Relato de uma Rara Neoplasia Maligna / Sacral Chordoma: Report of a Rare Malignant Neoplasm / Cordoma Sacral: Relato de uma Rara Neoplasia Maligna

Introdução: O cordoma é um tipo de sarcoma cuja malignidade óssea primária se origina da notocorda e se localiza no eixo espinhal entre o clivus e o sacro. A primeira descrição dessa patologia foi em 1857. Na epidemiologia da doença, são mais afetados pacientes entre 40 e 60 anos, sendo o principal sítio de acometimento a região sacrococcígea. O quadro clínico é variável conforme o local acometido com sintomas geralmente inespecíficos, gerando atrasos no diagnóstico feito por biópsia. Entre as opções de tratamento, o principal método é a ressecção cirúrgica com margens, que pode ser associada à radioterapia ou à radiocirurgia quando necessário; os sítios de metástases mais comuns são pulmões, ossos, fígado e linfonodos locais. Relato do caso: Paciente, sexo feminino, 62 anos, iniciou com quadro de dor em região coccígea com piora ao sentar-se e surgimento de lesão nodular com crescimento progressivo recebendo diagnóstico de cordoma, após biópsia da lesão, depois de três anos. Em razão da lesão extensa, optou-se inicialmente por tratamento com quimio e radioterapia para citorredução. Pela pouca responsividade, foi submetida ao tratamento de sacralectomia com sucesso, porém apresentou como complicação deiscência de ferida operatória e necessidade de reabordagem, desde então sem recorrência no seguimento clínico. Conclusão: Assim, evidencia-se a necessidade de novas pesquisas sobre o cordoma, um tumor raro e de baixa responsividade aos tratamentos não cirúrgicos, visando a melhorar a terapêutica quimioterápica dessa neoplasia potencialmente deformante.

Introduction: Chordoma is a type of sarcoma, a primary bone malignancy that originates from the notochord and is located on the spinal axis between the clivus and the sacrum. The first description of this pathology occurred in 1857. Patients between 40 and 60 years old are the most affected according to the disease's epidemiology, the main site involved is the sacral/coccygeal region. The clinical condition is variable depending on the site affected, with generally nonspecific symptoms, delaying the diagnosis made by biopsy. Among the treatment options, surgical resection with margins is currently the main method, and may be associated with radiotherapy or radiosurgery when necessary; the most common metastatic sites are lungs, bones, liver and local lymph nodes. Case report: A 62-year-old female patient had pain in the coccygeal region, worsening while sitting and the appearance of a nodular lesion with progressive growth, diagnosed as a chordoma three years later, after biopsy of the lesion. Due to the extensive lesion, initially she was submitted to chemotherapy and radiotherapy for cytoreduction, but because of the poor response, she was successfully submitted to sacralectomy, however, dehiscence of the surgical wound was detected, and the patient underwent a new approach; since then, no recurrence in the clinical follow-up. Conclusion: Apparently, it is clear the necessity for further investigations on chordoma, a rare tumor with poor response to non-surgical treatments, in order to improve the chemotherapy for this potentially deforming neoplasm.

Introducción: El cordoma es un tipo de sarcoma, una malignidad ósea primaria que se origina en la notocorda y se localiza en el eje espinal entre el clivus y el sacro. La primera descripción de esta patología fue en 1857. En la epidemiología de la enfermedad, los pacientes entre 40 y 60 años son los más afectados, siendo el principal sitio de afectación la región sacrocoxígea. El cuadro clínico es variable según el sitio afectado, con síntomas generalmente inespecíficos, lo que provoca retrasos en el diagnóstico realizado mediante biopsia. Entre las opciones de tratamiento, la resección quirúrgica con márgenes es actualmente el principal método, pudiendo asociarse a radioterapia o radiocirugía cuando sea necesario; los sitios más comunes de metástasis son los pulmones, los huesos, el hígado y los ganglios linfáticos locales. Informe del caso: Paciente, sexo femenino, de 62 años inició con dolor en la región coccígea, empeorando al sentarse y aparición de una lesión nodular con crecimiento progresivo, recibiendo diagnóstico de cordoma, luego de biopsia de la lesión, después de tres años. Debido a la extensión de la lesión optó inicialmente por tratamiento con quimio y radioterapia para citorreducción, por la poca reactividad fue sometida con éxito al tratamiento de sacralectomía, pero presentó como complicación dehiscencia de la herida quirúrgica y necesidad de reabordaje. Desde entonces sin recurrencia en el seguimiento clínico. Conclusión: Por lo tanto, es evidente la necesidad de seguir investigando sobre el cordoma, un tumor poco frecuente con escasa respuesta a los tratamientos no quirúrgicos, con el fin de mejorar la terapia de quimioterapia para esa neoplasia potencialmente deformante.

Sobrevivência aos Cânceres Ósseos e Reinserção Social / Survivorship to Osteosarcomas and Social Reinsertion / Supervivencia de los Cánceres de Hueso y Reinserción Social

Introdução: Pacientes com cânceres ósseos representam uma população singular com necessidades psicossociais pouco estudadas. Objetivo: Compreender o processo e o impacto da reinserção social para a vida cotidiana de adolescentes e adultos jovens após o tratamento e seguimento oncológico de cânceres ósseos. Método: Pesquisa qualitativa e exploratória, utilizando referencial metodológico da tradição hermenêutica com produção de dados por meio de entrevistas semiestruturadas com 12 sobreviventes de cânceres ósseos. Resultados: O material empírico foi organizado em três categorias: Reinserção social na família, Reinserção social na escola e Inserção na vida sociolaboral. Os desafios da reinserção social na família, escola e vida laboral de adolescentes e adultos jovens após o tratamento de câncer ósseo envolvem um complexo sentido de enfrentamento dos estigmas e limitações impostas pela doença e seu tratamento. Conclusão: As percepções e experiências dos sobreviventes ao câncer ósseo apontam para a vida social como um lugar de desafios e incertezas, perdas e lutos. É de extrema importância a existência de apoio multiprofissional especializado, assim como apoios familiar e social, para que esse grupo consiga suportes material e humano para enfrentar as mudanças decorrentes do tratamento oncológico

Introduction: Patients with bone cancer are a unique population with poorly investigated psychosocial needs. Objective: To understand the process and impact of social reintegration on the daily lives of adolescents and young adults after treatment and oncological follow-up of bone cancers. Method: Qualitative, exploratory, hermeneutic-based investigation with data obtained from semistructured interviews with 12 bone cancer survivors. Results: The empirical material was organized into three categories: Social reintegration into the family, Social reintegration at school and Insertion into social-labor life, which are challenging and involve a complex concept of coping with the stigmas and limitations imposed by the disease and its treatment. Conclusion: The emotions and experiences of cancer survivors indicate social life as a place of challenges and uncertainties, losses and grief. It is extremely important to count with specialized multidisciplinary support, as well as family and social background to enable this group to face cancer treatment related challenges

Introducción: Los pacientes con cáncer de huesos representan una población con necesidades psicosociales poco estudiadas. Objetivo: Comprender el proceso y el impacto de la reinserción social en la vida cotidiana de los adolescentes y adultos jóvenes después del tratamiento y seguimiento oncológico de los cánceres de huesos. Método: Investigación cualitativa y exploratoria, con referente metodológico de la tradición hermenéutica. La producción y el análisis de datos se basaron en 12 entrevistas semiestructuradas con sobrevivientes de cáncer de huesos. Resultados: El material empírico se organizó en tres categorías: Reinserción social en la familia, Reinserción social en la escuela e Inserción en la vida sociolaboral. Los desafíos de la reinserción social en la vida familiar, escolar y laboral de los adolescentes y jóvenes después del tratamiento del cáncer de huesos implican un sentido complejo de enfrentamiento de los estigmas y limitaciones que impone el cáncer y su tratamiento. Conclusión: Las emociones y experiencias de los sobrevivientes de cáncer apuntan a la vida social como un lugar de desafíos y choques, pérdida y duelo. Es de suma importancia contar con un apoyo multidisciplinario especializado, familiar y social, para que este grupo pueda obtener apoyo material y humano para enfrentar los cambios derivados del tratamiento del cáncer

Efectividad de intervenciones fisioterapéuticas pre y posoperatorias en pacientes con osteosarcoma / Effectiveness of pre-and postoperative physiother-apy interventions in patients with osteosarcoma

ResumenIntroducción:La falta de información sobre la efectividad de intervenciones fisioterapéuticas en la rehabilitación de pacientes con osteosarcoma en Ecuador ha llevado a evaluaciones tardías, aumentando la agresividad de la enfermedad.Materiales y métodos:En la investigación se propuso analizar la eficacia de la intervención fisioterapéutica en las fases pre y posoperatoria, recopilando información de 35 artículos cien-tíficos mediante un enfoque documental e inductivo. La calidad metodológica se evaluó con la escala PEDro, garantizando una puntuación ≥7 para validar los estudios. Se utilizaron bases de datos como Redalyc, ProQuest, LILACS, Scopus, PubMed, SJR, Cochrane, Scielo y PEDro, aplicando estrategias de búsqueda con operadores booleanos.Resultados:En la fase pre y posoperatoria se realizan intervenciones fisioterapéuticas como masajes, estimulación nerviosa, acupuntura, crioterapia y ejercicio, mostraron beneficios sig-nificativos en la disminución del dolor, la fatiga, la ansiedad, la depresión, mejoran la movilidad y fortalecen la musculatura.Conclusión:La aplicación dentro de un enfoque multidisciplinario en pacientes con osteosar-coma dio como resultadobienestar y mejoría sintomática. Este estudio respalda la eficacia de la fisioterapia en el tratamiento integral, permitiendo la independencia de los pacientes post-tratamiento quirúrgico y protésico, destacando la importancia de implementar estas in-tervenciones desde las fases iniciales del diagnóstico

AbstractIntroduction:The lack of information on the effectiveness of physiotherapy interventions forthe rehabilitation of patients withosteosarcoma in Ecuador has led to late evaluationsof this disease, increasing its aggressiveness. Materials and methods: The research aimed to analyze the effectiveness of the physiotherapy intervention in the pre-and postoperative phases, compiling information from 35 scientific ar-ticles through a documentary and inductive approach. Methodological quality was evaluated with the PEDro scale, guaranteeing a score ≥7 to validate the studies. Databases such as Re-dalyc, ProQuest, LILACS, Scopus, PubMed, SJR, Cochrane, Scielo, and PEDro were used, ap-plying search strategies with Boolean operators.Results: In the pre-andpostoperative phases, physiotherapeutic interventions such as mas-sage, nerve stimulation, acupuncture, cryotherapy, and exercise showedsignificant benefits in reducing pain, fatigue, anxiety, and depression, improving mobility,and strengthening mus-cles.Conclusion: Amultidisciplinary approach in patients with OS improved patientwell-being and symptoms. This study supports the effectiveness of physiotherapy in comprehensive treat-ment, allowing patients to become independentafter surgical and prosthetic treatment, high-lighting the importance of implementing these interventions from the initial phases of diagno-sis.

Characterization of Cell Subsets Associated With Prognosis of Osteosarcoma Based on Single-Cell Sequencing Data / 中国医学科学院学报

Objective To explore the cell subsets and characteristics related to the prognosis of osteosarcoma by analyzing the cellular composition of tumor tissue samples from different osteosarcoma patients.Methods The single-cell sequencing data and bulk sequencing data of different osteosarcoma patients were downloaded.We extracted the information of cell samples for dimensionality reduction,annotation,and cell function analysis,so as to identify the cell subsets and clarify the cell characteristics related to the prognosis of osteosarcoma.The development trajectory of macrophages with prognostic significance was analyzed,and the prognostic model of osteosarcoma was established based on the differentially expressed genes of macrophage differentiation.Results The cellular composition presented heterogeneity in the patients with osteosarcoma.The infiltration of mononuclear phagocytes in osteosarcoma had prognostic significance(P=0.003).Four macrophage subsets were associated with prognosis,and their signature transcription factors included RUNX3(+),ETS1(+),HOXD11(+),ZNF281(+),and PRRX1(+).Prog_Macro2 and Prog_Macro4 were located at the end of the developmental trajectory,and the prognostic ability of macrophage subsets increased with the progression of osteosarcoma.The prognostic model established based on the differentially expressed genes involved in macrophage differentiation can distinguish the survival rate of osteosarcoma patients with different risks(P<0.001).Conclusion Macrophage subsets are closely related to the prognosis of osteosarcoma and can be used as the key target cells for the immunotherapy of osteosarcoma.

Prognostic value and mechanism of long non-coding RNA DLEU1 in osteosarcoma / 中国骨伤

OBJECTIVE@#To investigate the prognostic value and mechanism of long non-coding RNA DLEU1(LncRNA DLEU1) in osteosarcoma.@*METHODS@#The tissue samples and clinical data of 86 patients with osteosarcoma treated by orthopaedic surgery in our hospital from January 2012 to December 2014 were retrospectively collected. The expression of LncRNA DLEU1 in pathological tissues was detected by qRT-PCR, then the patients were divided into high and low expression of LncRNA DLEU1 groups. Osteosarcoma cell line HOS was divided into two groups, down-regulated expression group (si-DLEU1 group) and negative control group (si-NC group). LncRNA DLEU1 siRNA and negative control sequence were transfected by Lipofectamine 3000. Chi-square test was used to analyze the relationship between the expression of LncRNA DLEU1 and the clinicopathological factors of osteosarcoma. Kaplan-Meier method was used to compare the difference of the overall survival rate of osteosarcoma patients between the high and low expression groups of LncRNA DLEU1. The risk factors affecting the overall survival rate of osteosarcoma were analyzed by single factor and multifactor analysis. The number of invasive cells in the two groups was determined and compared by Transwell assay.@*RESULTS@#The expression of LncRNA DLEU1 in osteosarcoma tissue was higher than that in adjacent tissues (P<0.001). The expression of LncRNA DLEU1 in human osteosarcoma cell lines (MG-63, U-2 OS, and HOS) was significantly higher than that in human osteoblast line hFOB 1.19 (P<0.001). The expression of LncRNA DLEU1 was significantly correlated with Enneking stage (P<0.001), distant metastasis (P=0.016), and histological grade (P=0.028). The 1-year overall survival rate of the LncRNA DLEU1 high expression group was significantly higher than that of the low expression group (90.7% vs 60.5%, P<0.001). The 5-year overall survival rate of the LncRNA DLEU1 high expression group was significantly higher than that of the low expression group (32.6% vs 11.6%, P<0.001). Univariate analysis showed that Enneking stage (P<0.001), tumor size (P=0.043), distant metastasis (P<0.001), histological grade (P<0.001), and expression of LncRNA DLEU1 (P<0.001) were risk factors for overall survival of osteosarcoma patients. Multivariate analysis showed that high expression of LncRNA DLEU1 [HR=1.948, 95% CI(1.141, 3.641), P=0.012] and distant metastasis[HR=4.108, 95% CI(2.169, 7.780), P<0.001] were independent risk factors for overall survival of osteosarcoma patients. The number of invasive cells in si-DLEU1 group was significantly lesser than that in si-NC group(139±13 vs 357±31, P<0.001).@*CONCLUSION@#High expression of LncRNA DLEU1 is a molecular marker affecting the prognosis of osteosarcoma patients. Downregulation of LncRNA DLEU1 can inhibit the invasion of osteosarcoma cells.

Primary malignant bone tumors incidence, mortality, and trends in China from 2000 to 2015 / 中华医学杂志(英文版)

BACKGROUND@#Primary malignant bone tumors are uncommon, and their epidemiological features are rarely reported. We aimed to study the incidence and death characteristics of bone tumors from 2000 to 2015.@*METHODS@#Population-based cancer registries submitted registry data to National Central Cancer Registry of China (NCCRC). The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of primary bone tumor were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi's world population. The annual percentage change (APC) in rate was calculated using the Joinpoint Regression Program.@*RESULTS@#Data from 368 registries met quality control criteria, of which 134 and 234 were from urban and rural areas, respectively. The data covered 309,553,499 persons. The crude incidence, age-standardized incidence, and crude mortality rates were 1.77, 1.35, and 1.31 per 100,000, respectively. Incidence and mortality rates were higher in males than those in females; they showed downward trends, with declines of 2.2% and 4.8% per year, respectively, and the rates in urban areas were lower than those in rural areas. Significant declining trends were observed in urban areas. Stable trends were seen in rural areas during 2000 to 2007, followed by downward trends. Age-specific incidence and mortality rates showed stable trends in the age group of 0 to 19 years, and downward trends in the age group elder than 19 years.@*CONCLUSIONS@#The incidence and mortality rates of primary malignant bone tumors in rural areas were higher compared to those in urban areas. Targeted prevention measures are required to monitor and control bone tumor incidence and improve the quality of life of affected patients. This research can provide a scientific basis for the prevention and control of bone tumors, as well as basic information for follow-up research.

Research progress in the mechanism and treatment of osteosarcoma / 中华医学杂志(英文版)

Osteosarcoma (OS) is the most common primary malignant bone tumor that more commonly occurs in children and adolescents. The most commonly used treatment for OS is surgery combined with chemotherapy, but the treatment outcomes are typically unsatisfactory. High rates of metastasis and post-treatment recurrence rates are major challenges in the treatment of OS. This underlines the need for studying the in-depth characterization of the pathogenetic mechanisms of OS and development of more effective therapeutic modalities. Previous studies have demonstrated the important role of the bone microenvironment and the regulation of signaling pathways in the occurrence and development of OS. In this review, we discussed the available evidence pertaining to the mechanisms of OS development and identified therapeutic targets for OS. We also summarized the available treatment modalities for OS and identified future priorities for therapeutics research.