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.

Diverse origin of Plasmodium falciparum in northwest Ecuador.

BACKGROUND: Ecuador plans to eliminate malaria by 2020, and the country has already seen a decrease in the number of cases from more than 100,000 in 2000 to only 618 in 2015. Around 30% of malaria infections in Ecuador are caused by Plasmodium falciparum. Most malaria population genetics studies performed in Latin America, especially in the Pacific Coast, indicate a high clonality and a clear structure of P. falciparum populations. It was shown that an outbreak of P. falciparum in northwest Ecuador was the result of a clonal expansion of parasites circulating at low levels in the country or re-invading Ecuador from neighbouring territories. However, general characteristics of P. falciparum circulating in the northwest coast of Ecuador have not been determined. The main goal of this study was to genetically characterize the population structure of P. falciparum in coastal Ecuadorian localities bordering with Colombia. METHODS: Molecular investigation of 41 samples collected from 2013 to 2016 in San Lorenzo County, northwest Ecuador was performed using seven neutral microsatellite markers. RESULTS: The genetic population structure of P. falciparum in northwest Ecuador is clearly defined as three different genetic groups previously reported in Ecuador, Peru and Colombia. CONCLUSIONS: The limited number of P. falciparum clonal types that are circulating in northwest Ecuador, are related to ancestral parasite clonal lineages reported in the Pacific Coast. These parasites could be a product of migration from neighbouring regions or residual clonal types circulating in the country in low proportions. Studies of the genetic characterization of P. falciparum in eliminating areas help determine the possible origin of parasites in order to create strategies to prevent the entrance of new lineages and achieve local elimination of malaria.

Abordaje del acné desde atención primaria / Approaching acne from primary care

El Acné es un motivo de consulta dermatológica frecuente en la población joven de atención primaria (APS), que sin ser una patología de urgencia, se asocia a complicaciones estéticas y/o psicológicas que tienen un gran impacto en la calidad de vida del paciente. En su fisiopatología interactúan una serie de factores tales como: la queratinización anormal de la piel, y consiguiente obstrucción de la unidad pilosebácea, con posterior formación de microcomedones. El aumento del sebo, permite la colonización del P. Acnes y la consecuente cascada inflamatoria. Aunque no existe un consenso en cuanto a la clasificación, estas se pueden dividir en lesiones inflamatorias (pápulas, pústulas, nódulos o quística) o no-inflamatoria, (comedoniano). El tratamiento está orientado al tipo de lesión y su severidad. El arsenal farmacológico en APS considera el tratamiento tópico (retinoides y/o antibióticos) indicado a través de recetas magistrales y antibióticos orales para casos más avanzados. Sin embargo, a pesar de ser una patología manejable en APS, se debe tener en consideración la necesidad de derivación en casos determinados.

Acne is a frequent reason for dermatological consultation in the young population of primary care (PHC), which without being an emergency pathology, is associated with aesthetic and/or psychological complications that have a great impact on the quality of life of the patient. A series of factors interact in its physiopathology, such as: abnormal keratinization of the skin, and consequent obstruction of the pilosebaceous unit, with subsequent formation of microcomedons. The increase of sebum allows the colonization of P. Acnes and the consequent inflammatory cascade. Although there is no consensus as to the classification, these can be divided into inflammatory (papules, pustules, nodules or cystic) or non-inflammatory (comedonian) lesions. Treatment is oriented to the type of lesion and its severity. The pharmacological arsenal in APS considers topical treatment (retinoids and/or antibiotics) indicated through master prescriptions and oral antibiotics for more advanced cases. However, despite being a manageable pathology in PHC, the need for referral in certain cases must be taken into consideration.

Candidate genes and QTLs for fruit ripening and softening in melon.

Different factors affect the quality of melon fruit and among them long shelf life is critical from the consumer's point of view. In melon, cultivars showing both climacteric and non-climacteric ripening types are found. In this study we have investigated climacteric ripening and fruit softening using a collection of near-isogenic lines (NILs) derived from the non-climacteric melon parental lines PI 161375 (SC) and "Piel de Sapo" (PS). Surprisingly, we found that QTL eth3.5 in NIL SC3-5b induced a climacteric-ripening phenotype with increased respiration and ethylene levels. Data suggest that the non-climacteric phenotypes from PI 161375 and "Piel de Sapo" may be the result of mutations in different genes. Several QTLs for fruit flesh firmness were also detected. Candidate genes putatively involved in ethylene regulation, biosynthesis and perception and cell wall degradation were mapped and some colocations with QTLs were observed. These results may provide additional data towards understanding of non-climacteric ripening in melon.