Prospects for the involvement of cancer stem cells in the pathogenesis of osteosarcoma.

Osteosarcoma (OS) is one of the most common bone tumors in children and adolescents that cause a high rate of mortality in this age group and tends to be metastatic, in spite of chemotherapy and surgery. The main reason for this can be returned to a small group of malignant cells called cancer stem cells (CSCs). OS-CSCs play a key role in the resistance to treatment and relapse and metastasis through self-renewal and differentiation abilities. In this review, we intend to go through the different aspects of this malignant disease, including the cancer stem cell-phenotype, methods for isolating CSCs, signaling pathways, and molecular markers in this disease, and drugs showing resistance in treatment efforts of OS.

Innovative approach to managing acromion fracture and acromioclavicular joint dislocation: A case report.

INTRODUCTION: This study delves into the management of acromion fractures and acromioclavicular (AC) joint dislocations-orthopedic injuries with significant implications for shoulder function. Despite their infrequency, these injuries present challenges due to potential persistent pain and functional limitations. Current treatment strategies span from conservative measures to surgical interventions, yet there exists a notable gap in comprehensive data on specific surgical approaches. PRESENTATION OF CASE: We present a compelling case involving a 38-year-old male athlete who sought medical attention following a motor vehicle accident due to severe right shoulder pain. Upon admission to the emergency ward, the patient reported an inability to move the affected shoulder. Radiographic evaluations, comprising X-ray and computerized tomography scans, revealed a displaced fracture at the base of the acromion coupled with an AC dislocation. A novel surgical technique was employed, featuring coracoid fixation with mersilene thread and a 2-hole reconstruction plate-a distinctive approach in the field. DISCUSSION: The systematic rehabilitation plan yielded successful healing and the restoration of normal shoulder function, offering promising insights into potential advancements in orthopedic practices. CONCLUSION: This case contributes valuable knowledge to the understanding of these complex injuries, paving the way for further exploration and refinement in their management. The innovative surgical approach showcased underscores the importance of continued research and exploration to enhance the overall treatment landscape for acromion fractures and AC joint dislocations.

Outdoor air pollution exposure, bone mineral density, osteoporosis, and osteoporotic fractures: A systematic review and meta-analysis.

BACKGROUND: The prevalence of osteoporosis and osteoporotic fractures is expected to increase with the aging of the population in the coming decades. In this study, we systematically reviewed the evidence on the association between exposure to air pollution and osteoporosis-related outcomes. METHODS: We systematically searched evidence according to the PRISMA on PubMed, Scopus, and Web of Science (until August 2022). The risk of bias (RoB) was assessed using the Risk of Bias in the Non-randomized Studies of Exposures (ROBINS-E) tool. Random effects meta-analysis was applied to calculate combined estimates. We evaluated the heterogeneity using Cochran's Q test and quantified it by I2 and tau2 statistics. The overall body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) tool. RESULTS: Out of 5254 retrieved articles, 19 studies (11 cross-sectional, seven cohorts, and one case-control) met our inclusion criteria. Most of the studies had a high probability of RoB (n = 17), and only two had a moderate RoB. Different outcomes including bone mineral density, bone mineral content, osteoporotic fracture, osteoporosis, and osteopenia were reported across the studies. The associations were reported for different air pollutants including PM2.5, PM10, nitrogen oxides, nitrogen dioxide, ozone, black carbon, carbon monoxide, sulfur dioxide, nitrogen oxide, and coarse particulate matter. Evidence was suggestive of the negative role of PM10, PM2.5, and nitrogen dioxide (e.g. bone mineral density pooled estimate: -0.02, 95%CI: -0.03: -0.01). The overall body of evidence for most of the exposure-outcome pairs was low and very low. CONCLUSIONS: The evidence on the association between air pollution exposure and osteoporosis-related outcomes is heterogenic. However, the evidence suggests an increased risk of osteoporotic fracture and osteoporosis in outdoor air pollutants. Due to the small number of studies in each group, also observed heterogeneity, and publication bias, the results should be interpreted with caution.

The efficacy of hemiepiphysiodesis for idiopathic knee coronal angular deformity by reconstruction plate and screw: A pilot study.

Background: Angular deformities of the lower extremities are among the most common findings in pediatric orthopedics. Alteration of the mechanical axis in the lower extremity affects the cosmetic appearance and may lead to gait disturbances, knee discomfort, patellar maltracking with or without pain, and early joint osteoarthritis. In the current study, we aimed to investigate the efficacy of 3-hole 3.5 mm reconstruction plates in tension-band temporary hemiepiphysiodesis for correcting idiopathic knee coronal angular deformities. Methods: The surgical procedure was performed using an extraperiosteal tension band plate (a 3-hole reconstruction plate) and two 3.5 mm cortical screws to treat idiopathic knee coronal angular deformity in children. The location of the hemiepiphysiodesis was determined based on the type of angular deformity present. Postoperative follow-ups were conducted through x-rays to measure the medial proximal tibial angle and lateral distal femoral angle of the limbs. Statistical analysis was then performed to evaluate the efficacy of the surgical treatment based on the rate of alignment change exhibited. Results: The study included 14 patients (25 limbs) with genu valgum deformity who underwent temporary hemiepiphysiodesis on both the distal femur and proximal tibia, with 16 proximal tibias and 15 distal femurs being corrected. The correction rate for genu valgum was found to be 0.59° per month for both proximal tibial and distal femoral hemiepiphysiodesis. Six patients (12 limbs) were also identified with genu varum deformity, and the correction rates for proximal tibial lateral hemiepiphysiodesis and distal femoral lateral hemiepiphysiodesis were 0.85° and 0.15° per month, respectively. During a mean follow-up duration of 11 ± 5.7 months, only one case of physeal plate closure was observed, and there were no other significant complications. Conclusion: Temporary hemiepiphysiodesis with a 3-hole R-plate and two cortical screws takes advantage of physiological physeal growth to successfully treat idiopathic angular deformities with low complication rates.