Controversies in orthopaedic oncology.

Chondrosarcoma is the second most common surgically treated primary bone sarcoma. Despite a large number of scientific papers in the literature, there is still significant controversy about diagnostics, treatment of the primary tumour, subtypes, and complications. Therefore, consensus on its day-to-day treatment decisions is needed. In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) attempted to gain global consensus from 300 delegates from over 50 countries. The meeting focused on these critical areas and aimed to generate consensus statements based on evidence amalgamation and expert opinion from diverse geographical regions. In parallel, periprosthetic joint infection (PJI) in oncological reconstructions poses unique challenges due to factors such as adjuvant treatments, large exposures, and the complexity of surgery. The meeting debated two-stage revisions, antibiotic prophylaxis, managing acute PJI in patients undergoing chemotherapy, and defining the best strategies for wound management and allograft reconstruction. The objectives of the meeting extended beyond resolving immediate controversies. It sought to foster global collaboration among specialists attending the meeting, and to encourage future research projects to address unsolved dilemmas. By highlighting areas of disagreement and promoting collaborative research endeavours, this initiative aims to enhance treatment standards and potentially improve outcomes for patients globally. This paper sets out some of the controversies and questions that were debated in the meeting.

Clinical outcomes of total femoral replacement. First Latin American experience.

INTRODUCTION: The femur is frequently affected by primary and metastatic bone tumors. In cases with substantial bone loss, Total Femur Replacement (TFR) remains the only viable limb preservation option. This study investigates the clinical outcomes of TFR patients in a Latin American setting, with a minimum 3-year follow-up. METHODS: Retrospective review identifying cases of TFR at a single center from 2009 to 2020. Patients who had TFR either due to oncological indications or complications arising from oncology-related surgeries were included. Data on the indications for surgery and post-operative complications were recorded. To assess functional status, the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS) were used. RESULTS: Fourteen patients met the inclusion criteria. Diagnoses included eight osteosarcomas, four chondrosarcomas, one Ewing sarcoma, and one giant cell tumor. Ten patients had undergone prior surgeries. Indication for TFR was a complication of a previous surgery in 78.6 % of cases. Post-TFR complications were experienced by 35.7 % of patients, requiring further surgeries. At the 3-year mark, average MSTS and TESS scores were 67.4 % and 70.8 %, respectively. CONCLUSION: Total femur replacement serves as a valuable limb salvage solution for patients with significant femoral defects in oncological scenarios, however, there is a significant risk of complications. Given its potential benefits, it is essential for developing countries to consider incorporating TFR into their healthcare systems.

Collagen microgel to simulate the adipocyte microenvironment for in vitro research on obesity.

Obesity is linked to adipose tissue dysfunction, a dynamic endocrine organ. Two-dimensional cultures present technical hurdles hampering their ability to follow individual or cell groups for metabolic disease research. Three-dimensional type I collagen microgels with embedded adipocytes have not been thoroughly investigated to evaluate adipogenic maintenance as instrument for studying metabolic disorders. We aimed to develop a novel tunable Col-I microgel simulating the adipocyte microenvironment to maintain differentiated cells with only insulin as in vitro model for obesity research. Adipocytes were cultured and encapsulated in collagen microgels at different concentrations (2, 3 and 4 mg/mL). Collagen microgels at 3 and 4 mg/mL were more stable after 8 days of culture. However, cell viability and metabolic activity were maintained at 2 and 3 mg/mL, respectively. Cell morphology, lipid mobilization and adipogenic gene expression demonstrated the maintenance of adipocyte phenotype in an in vitro microenvironment. We demonstrated the adequate stability and biocompatibility of the collagen microgel at 3 mg/mL. Cell and molecular analysis confirmed that adipocyte phenotype is maintained over time in the absence of adipogenic factors. These findings will help better understand and open new avenues for research on adipocyte metabolism and obesity. Insight box In the context of adipose tissue dysfunction research, new struggles have arisen owing to the difficulty of cellular maintenance in 2D cultures. Herein, we sought a novel approach using a 3D type I collagen-based biomaterial to adipocyte culture with only insulin. This component was tailored as a microgel in different concentrations to support the growth and survival of adipocytes. We demonstrate that adipocyte phenotype is maintained and key adipogenesis regulators and markers are over time. The cumulative results unveil the practical advantage of this microgel platform as an in vitro model to study adipocyte dysfunction and obesity.

Functionalized Collagen/Poly(ethylene glycol) Diacrylate Interpenetrating Network Hydrogel Enhances Beta Pancreatic Cell Sustenance.

Three-dimensional matrices are a new strategy used to tackle type I diabetes, a chronic metabolic disease characterized by the destruction of beta pancreatic cells. Type I collagen is an abundant extracellular matrix (ECM), a component that has been used to support cell growth. However, pure collagen possesses some difficulties, including a low stiffness and strength and a high susceptibility to cell-mediated contraction. Therefore, we developed a collagen hydrogel with a poly (ethylene glycol) diacrylate (PEGDA) interpenetrating network (IPN), functionalized with vascular endothelial growth factor (VEGF) to mimic the pancreatic environment for the sustenance of beta pancreatic cells. We analyzed the physicochemical characteristics of the hydrogels and found that they were successfully synthesized. The mechanical behavior of the hydrogels improved with the addition of VEGF, and the swelling degree and the degradation were stable over time. In addition, it was found that 5 ng/mL VEGF-functionalized collagen/PEGDA IPN hydrogels sustained and enhanced the viability, proliferation, respiratory capacity, and functionality of beta pancreatic cells. Hence, this is a potential candidate for future preclinical evaluation, which may be favorable for diabetes treatment.

Collagen-mesenchymal stem cell spheroids in suspension promote high adipogenic capacity.

Human mesenchymal stem cells (hMSC) represent a unique and promising platform because of their ability to promote soft tissue regeneration, particularly their ability to differentiate into adipocytes, which are important for adipose tissue regeneration. In this context, type I collagen is the most abundant extracellular matrix component of adipose tissue and can act as a natural spheroid source to support the differentiation process of stem cells. However, spheroids based on collagen and hMSCs without numerous pro-adipogenic factors that can induce adipogenesis have not yet been investigated. In this study, we focused on developing collagen-hMSC spheroids capable of differentiating into adipocyte-like cells in a short time (eight culture days) without adipogenic factors, with potential applications in adipose tissue repair. The physical and chemical properties of the spheroids indicated successful cross-linking of collagen. Upon spheroid development, stability, cell viability, and metabolic activity of the constructs were maintained. During adipogenesis, cell morphology shows significant changes, in which cells change from a fibroblast-like shape to an adipocyte-like shape, and adipogenic gene expression after eight days of cell culture. These results support the utility of collagen-hMSC 3 mg ml-1collagen concentration spheroids to differentiate into adipocyte-like cells in a short time without adverse effects on biocompatibility, metabolic activity, or cell morphology, suggesting that this construct may be used in soft tissue engineering.

Anotación semátiica de imágenes médiaas / Semantic Annotation of Medical Images

El uso de ontologías para facilitar la anotación semántica de imágenes médicas ha sido un enfoque ampliamente utilizado. Una limitación particular de este enfoque, es el reducido número de ontologías con un alto nivel de completitud, debido en parte, a la dificultad que representa su evolución. En este artículo se propone un método que facilita la evolución de ontologías a partir de las contribuciones hechas por expertos de dominio mediante el etiquetado social de imágenes médicas. El método guía el proceso colaborativo durante el descubrimiento del cambio. Adicionalmente, se presenta una herramienta construida sobre Web Protégé para dar soporte al método propuesto.

The use of ontologies to facilitate semantic annotation of medical images has been a widely used approach. A particular limitation of this approach is the lack of ontologies with a high level of completeness, mainly because the problem that ontology evolution represent. This article proposes an approach that facilitates the evolution of ontologies from the contributions made by domain experts through social tagging of medical images. The method guides the collaborative process during the discovery of change. Additionally, we present a tool build on Web Protégé to support the proposed method.

Significado de los pólipos en colon distal, en una población de un país en vía de desarrollo: prevalencia y asociación con neoplasia proximal sincrónica / Significance of polyps in the distal colon in a population in a developing country: prevalence and association with synchronous proximal neoplasia

El cáncer colorectal (CCR) representa la segunda causa de mortalidad por cáncer a nivel mundial, con una supervivencia promedio a cinco años inferior a 55%. La presencia de pólipos adenomatosos constituye el principal factor de riesgo asociado al desarrollo de CCR; así, la remoción temprana de éstos ha demostrado ser una intervención costo efectiva para reducir la incidencia de CCR. La prevalencia de pólipos colónicos tomada de países con alta incidencia varía entre 12% y 25% para aquéllos de localización distal, 21% y 27% en casos de localización proximal y 9% y 13,5% para casos de lesión proximal con pólipo sincrónico distal. No se dispone en Colombia de estudios que evalúen la prevalencia y el significado de los pólipos colónicos de localización distal Objetivos: estimar la prevalencia de pólipos en colon distal en pacientes remitidos para sigmoidoscopia diagnóstica y medir el riesgo de presentar neoplasia proximal sincrónica. Pacientes y métodos: estudio “cross-sectional”. Se evaluaron consecutivamente 4044 sujetos mayores de 14 años, 3903 (96,5%) cumplieron criterios de inclusión; se les aplicó un formulario previo a la realización del procedimiento endoscópico. En todos los casos en que se encontró pólipos en la sigmoidoscopia, se practicó colonoscopia total. Resultados: para la población general la edad promedio fue de 48,51 (DE = 16,27), 54,3% correspondió al sexo masculino. Para sujetos con pólipos distales la edad promedio fue de 56,53 (DE = 15,53). La prevalencia de pólipos distales fue de 8,19% (320/3903), de 7,3% (88/1210) para los de localización proximal y 14,4% (42/980) para lesión proximal con lesión distal sincrónica. El riesgo de neoplasia proximal se incrementó en más de tres veces con la presencia de pólipo colónico distal (OR = 3,39, IC 95% 2,14-5,38). El riesgo de presentar neoplasia proximal sincrónica en pacientes de 60 años o mayores, fue significativamente superior (OR = 3,99, IC 95% 2,36=6,79). Conclusiones: la prevalencia de pólipos colónicos de localización distal (8,19%), proximal (7,3%) y proximal sin lesión distal (4,7%) en la población estudiada, es significativamente menor comparada con la encontrada en países desarrollados. No obstante la identificación de esta lesión mediante la sigmoidoscopia, independiente del tamaño del pólipo y del tipo histológico, incrementan notablemente la probabilidad de neoplasia proximal. En consecuencia, la identificación de cualquier pólipo durante la sigmoidoscopia justifica con alto grado de confiabilidad la práctica de colonoscopia total. La prevalencia de neoplasia proximal sin lesión distal (9%) se asimila a la de los países desarrollados; de otra parte el riesgo de encontrar neoplasia sincrónica proximal se incrementa ostensiblemente en población mayor a 60 años. Por lo tanto nosotros sugerimos en pacientes mayores a 60 años la realización de colonoscopia total.

Colorectal cancer (CCR) represents the second cause of mortality for cancer in the world, with a 5 year survival average less than 55%. The presence of adenomatous polyps constitutes the main risk factor associated to the development of CCR and their early removal has demonstrated to be an effective cost intervention to reduce the incidence of CCR. Prevalence of colonic polyps in countries with high incidence varies between 12%-25% for those of distal location, 21%-27% for proximal location and 9%-13,5% for those with proximal lesions and synchronous distal polyp. We do not have in lang=EN-US>Colombia studies that evaluate the prevalence and the meaning of the colonic polyps of distal location Objectives: to estimate the prevalence of polyps in the distal colon (DP) in patients studied with a diagnostic sigmoidoscopy and to calculate the risk of suffering a synchronous proximal neoplasia. Patient and methods: we used a designed “cross-sectional”, study 4044 patients were studied consecutively, older than 14 years, 3903 (96,5%) completed inclusion criteria. These were applied previously to the endoscopic performance. In the whole of the cases when a polyp was found a colonoscopy was done Results: the general mean age was 48,51 yr (OF = 16,27), 54.3% males. For subjects with DP it was 56,53 yr (OF = 15,53). The prevalence of DP was 8,19% (320/3903), of 7.3% (88/1210) for those of localization proximal and 14,4% (42/980) for those with proximal and synchronous distal lesions. The risk of proximal neoplasia was increased in more than three times with the presence of colonic DP (OR = 3,39, IC 95% 2.14-5.38) and this risk is still bigger in patients with or older than 60 years (OR = 3,99, IC 95% 2,36=6,79 ). Conclusions: The prevalence of colonic DP (8,19%), proximal (7,3%) and proximal without lesion distal (4,7%) in the studied population is significantly smaller compared with the opposing one in developed countries. Nevertheless, the identification of this lesion in a sigmoidoscopy , independent of the size and of the histological type, increases the probability of a proximal neoplasia and this finding indicates that a colonoscopy must be done. The prevalence of a proximal neoplasia without DP (9%) is similar to that described in developed countries. On the other hand the risk of finding a synchronous proximal neoplasia is ostensibly increased in older than 60 years and therefore we suggest that in this group of patients a complete colonoscopy must be done.

Características clínicas, endoscópicas e histológicas de la gastritis petequial

Objetivo: Estudiar las características de la gastritis fúndica de aspecto peteuial (GFP). Se estudiaron 50 pacientes con GFP y compararon con otros 21 con gastritis eritomatosa plana antral, encontrándose diferencias en el aspecto endoscópico e histológico, con mejoria a corto plazo en dos terceras partes con el tratamiento de erradicación del Helicobacter pylori y normalización en una tercera parte a los 16 meses. La GFP está asociada con la infección por Helicobacter pylori, el cual debe erradicarse

Paracoccidioidomicosis genital femenina: informe de un caso / Female genital paracoccidioidomycosis: report of a case

Se presenta el caso de una mujer de 47 anos de edad quien fue remitida a la Unidad de Ginecologia del Hospital General Universitario Santa Sofia para estudio colposcopico por citologia anormal. Imagen fue sugestiva de Neoplasia Intraepitelial Cervical pero en estudio histologico de biopsias tomadas de zonas acetoblancas, con mosaico y punteado revelaron la presencia de reaccion granulomatosa con estructuras de hongos de doble pared y morfologia del Paracoccidioides Braziliensis. Estudio sistemico de la paciente habia revelado compromiso pulmonar con cambios de laboratorio de infeccion paracoccidioidal que fue tratado un ano antes en forma inconstante con sulfas. Este informe presenta un caso observado recientemente, con compromiso sistemico y presentacion clinica prominente en genitales femeninos (cervis-uretra-vagina) siendo su manifestacion clinica y colposcopicocitologica, sugestiva de Neoplasia