Plate-assisted bone segment transport: Novel application on distal tibia defect after tumour resection. A case report.

INTRODUCTION: Reconstruction of a large bone defect of the distal tibia after limb salvage surgery is difficult. The options include custom-made ankle endoprosthetic replacement, arthrodesis, and biological or metallic intercalary reconstructions. This report introduces a technique that provides the patient with a long-lasting biological reconstruction while preserving the native ankle. PRESENTATION OF CASE: We present the case of a 47-year-old man with osteosarcoma of the distal tibia. After neoadjuvant chemotherapy, wide excision was performed while preserving the ankle joint. Bone reconstruction by Plate-assisted bone segment transport (PABST) was performed with a non-invasive growing intramedullary nail. At 34 months of follow-up, there was solid union and the Musculoskeletal Tumour Society Score was 26/30. DISCUSSION: This is the first report of PABST after distal tibia tumour resection. It shows that this is a viable and safe method of reconstruction. Despite the use of adjuvant chemotherapy, regenerate was formed and union was achieved. CONCLUSION: PABST is a useful tool in the armamentarium to tackle difficult large bone defects.

Transfer of the anterior gluteus maximus to address abductor deficiency following soft tissue tumour excision.

Hip abductor deficiency is most commonly encountered in the context of degeneration of the hip, and techniques for reconstruction pioneered by arthroplasty surgeons. We adopted a local muscle transfer technique utilizing the anterior half of the gluteus maximus for abductor reconstruction following soft tissue tumour excision in a young female patient. The patient of concern had a solitary fibrous tumour located between the right gluteus medius and minimus detected as an incidental finding. Marginal excision of the mass resulted in removal of the gluteus medius. The anterior half of the gluteus maximus was transferred and attached to the decorticated lateral greater trochanter by means of suture anchors and transosseous sutures. The patient initially demonstrated a Trendelenburg gait and limited abduction against gravity. By 1-year post-operation, there was return of normal gait and recovery of hip abductor power. This is the first report of anterior gluteus maximus transfer being successfully applied for soft tissue reconstruction around the hip subsequent to tumour excision.

Genetic and clonal dissection of osteosarcoma progression and lung metastasis.

Osteosarcoma is a primary malignant bone tumor that has a high potential to metastasize to lungs. Little is known about the mechanisms underlying the dissemination of OS cancer cells to lungs. We performed whole exome sequencing of 13 OS primary tumors, with matched lung metastases and normal tissues. Phylogenetic analyses revealed that lung metastatic tumors often harbor clones that are nonexistent or rare in the matched primary OS tumors. Spatially and temporally separated lung metastases were from parallel seeding events with a polyphyletic pattern. Loss of TP53 or RB1 is among the early events during OS tumorigenesis, while loss of PTEN is involved at the later stages associated with lung metastases. Finally, KEAP1 was identified as a novel biomarker for increased metastatic risk. Patients whose primary tumors harbored KEAP1 amplification have significantly poorer lung-metastasis free survival. This finding was validated in two independent datasets. Further, in vitro experiments exhibited that KEAP1 depletion suppressed the invasion of OS cells. Our findings uncover the patterns of clonal evolution during OS progression and highlight KEAP1 as a novel candidate associated with the risk of lung metastasis in OS patients.

Exploring the Sacred-Secular Dialect in Everyday Social Work Practice: An Analysis of Religious Responses to Managerialism among Outreach Social Workers in Hong Kong.

We examine the recent proliferation of religious discourses among front line social workers in the former British Colony of Hong Kong in order to explore the nature of 're-enchantment' in modern social work practice. In-depth qualitative interviews with twenty social workers who identify as 'Christian social workers' in a variety of social work organisations (both religious and secular) reveal the adoption of religious identities and discourses to navigate the encroachment of managerialism. A systematic analysis of these narratives suggests that Christian social workers evoke religion to reclaim feelings of authenticity in their work, to facilitate more personalised relationships with their clients, and to empower themselves following the introduction of managerialist policies. We illuminate the dialectical relationship between religious discourses and managerialism to critique claims in the literature about a 're-enchantment' in social work, and to understand the essence of religion in modern social work practice.