Survey of Palliative Care Use in Primary Malignant Bone Tumors: A National Cancer Database Review.

Background/Objectives: Palliative care (PC) has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Design/Setting and Subjects: Patients diagnosed with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma) between 2004 and 2018 were identified in the National Cancer Database. Cross tabulations with chi-square analysis were performed to evaluate frequencies of PC use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of PC. Results: Around 24,401 patients were identified. Overall, 2.52% had any form of PC utilization. Of those receiving PC, 55.5-65.1% were treated with only noncurative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of PC utilization were decreased for patients with chordomas, patients living >24 miles from the treatment facility, or patients with private insurance, Medicare, or unknown insurance status. Odds of PC utilization were increased in patients with greater tumor diameter or unknown tumor size, tumors in midline, increased tumor grade, stage IV tumors, or living in urban areas. Conclusion: PC use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, and if the tumor is midline, and in patients living in urban areas. However, overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of PC.

Distal tibiofibular syndesmosis reconstruction using a free hamstring autograft.

BACKGROUND: Chronic instability of the distal tibiofibular syndesmosis and its treatment is infrequently described in the literature. We report our results for treating this condition with a reconstruction based on restoration of near normal anatomy with a hamstring autograft. MATERIALS AND METHODS: Eight patients, who had chronic distal tibiofibular syndesmosis instability diagnosed arthroscopically underwent reconstruction of the distal anterior tibiofibular ligament and the transverse interosseus ligament using a free semi-tendinosis hamstring autograft. A radiographic and clinical review of the patients was performed. The average followup was 39 (range, 9 to 86) months. RESULTS: The postoperative visual analogue pain score was 19 out of 100 compared to 73 out of 100 preoperatively. The postoperative mean AOFAS score was 85.4 (range, 49 to 100), the SF-36 score was 81 (range, 56 to 92) and the Maryland foot score was 89.3 (range, 63 to 100). CONCLUSION: Chronic instability of the distal tibiofibular syndesmosis is an infrequent problem but disabling when it occurs. Our results show an improved VAS score for pain, improved swelling and instability symptoms as well as SF-36, AOFAS and Maryland scores. We would recommend this method to reconstruct the anterior tibiofibular ligament and the transverse interosseus ligament which has failed to respond to debridement alone.

Neuroglobin protects PC12 cells against oxidative stress.

Neuroglobin (Ngb) is a newly discovered globin in the vertebrate brain that exhibits neuroprotection against hypoxic/ischemic injury. Hypoxic/ischemic brain injury is associated with accumulation of reactive oxygen species (ROS) and/or reactive nitrogen species (RNS), and antioxidants or ROS scavengers promote cell survival. Therefore, Ngb may serve as a scavenger of toxic reactive species, such as hydrogen peroxide. To examine the anti-oxidative role of neuroglobin, PC12 cells were transfected with wild type and mutant (H64 V/H96A) Ngb for 48 h and then treated with H2O2 (0.1, 0.2 and 0.4 mM) for 6 h. Ngb siRNA decreased the H2O2-induced Ngb expression and exacerbated H2O2-induced cell injury. Transient transfection of Ngb induced dose-dependent increases in Ngb protein expression and did not alter SOD, GPX, and catalase activities. Overexpression of wild type Ngb, but not of mutant Ngb, significantly attenuated H2O2-induced ROS/RNS accumulation and lipid peroxidation, decreased H2O2-induced mitochondrial dysfunction and apoptosis, and promoted overall cell survival. Thus, Ngb plays a protective role against oxidative stress, which appears to be primarily mediated by intrinsic Ngb antioxidant properties.

Neuroglobin protects PC12 cells against beta-amyloid-induced cell injury.

Excessive accumulation of amyloid beta (Abeta) has been proposed as a pivotal event in the pathogenesis of Alzheimer's disease. Possible mechanisms underlying Abeta-induced neuronal cytotoxicity include excess production of reactive oxidative species (ROS) and apoptosis. Neuroglobin (Ngb), a newly discovered globin in vertebrates that exhibits neuroprotective functions, may have a potential role in scavenging ROS. To examine the potential protective role of Ngb in Abeta-induced cytotoxicity, PC12 cells were treated with Abeta (1-42 fragment) for 24h. Abeta treatments increased ROS production in PC12 cells. Overexpression of Ngb but not Ngb mutant in the PC12 cells significantly attenuated Abeta-induced ROS production and lipids peroxidation. Furthermore, overexpression of Ngb also attenuated Abeta-induced mitochondrial dysfunction and apoptosis, and promoted cell survival in PC12 cells. Therefore, Ngb may act as an intracellular ROS scavenger, and such antioxidant properties may play a protective role against Abeta-induced cell injury.

Subacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial.

Subacromial decompression surgery is associated with significant postoperative pain. We compared interscalene block (ISB) with subacromial bursa block (SBB). Sixty consecutive patients with subacromial impingement syndrome, scheduled for arthroscopic subacromial decompression surgery, were randomized into 3 groups receiving ISB (n = 19), SBB (n = 19), or no block (n = 15 [controls]). Patients with rotator cuff tears were excluded (n = 7). The postoperative consumption of morphine, time to the first bolus of morphine, oral analgesia, pain, sickness, and sedation scores were recorded. The pain scores in the ISB and SBB groups were lower than those in the control group in the first 12 hours postoperatively. The control group consumed more morphine (mean, 32.3 mg) compared with the SBB group (mean, 21.21 mg) and ISB group (mean, 14.00 mg) (P < .001). The time to first bolus was earlier in the control group (mean, 42.1 minutes) compared with both the SBB (mean, 92.6 minutes) and ISB (mean, 119.0 minutes) groups (P < .001). The oral analgesic intake was less in the SBB and ISB groups than in the controls (P = .004). Although ISB remains the gold standard, SBB provides effective, safe, and easily administered postoperative analgesia in patients with an intact rotator cuff undergoing arthroscopic subacromial decompression.

Do mitochondrial DNA haplogroups play a role in susceptibility to tuberculosis?

BACKGROUND AND OBJECTIVES: Mitochondrial DNA has a unique role in ATP production and subsequent mitochondrial reactive oxygen species (ROS) production in eukaryotic cells and there is a potential role for ROS and oxygen burst against Mycobacterium tuberculosis, an intracellular pathogen. This study aimed to determine whether the frequency of different mitochondrial haplogroups was significantly different in patients with tuberculosis (TB) compared with a normal population. METHODS: Mitochondrial DNA haplogroups M, N, J and K were studied by PCR-restriction fragment length polymorphism and sequencing. Cases were 54 patients with confirmed smear positive pulmonary TB. Controls were 256 healthy persons. RESULTS: There were no statistically significant differences between those with TB and the control group. CONCLUSIONS: There was no statistically significant association between mtDNA haplogroups and the presence of TB infection.

Trends of drug resistant Mycobacterium tuberculosis in a tertiary tuberculosis center in Iran.

OBJECTIVE: To determine the drug resistance pattern to first line antituberculous drugs in National Research Institute of Tuberculosis and Lung Disease and to compare resistant rates with previous studies. METHODS: An anterograde cross-sectional study was performed. The study includes all adults with documented pulmonary tuberculosis (TB) that were hospitalized in National Research Institute of Tuberculosis and Lung Disease in Tehran, from June 2003 to September 2004. Demographic characteristic, TB categories, and drug susceptibility test results were recorded. Two previous studies regarding drug susceptibility in Iran were selected as historical controls. RESULTS: One hundred and ninety-six new cases and 68 previously treated patients were enrolled in the study. The strains of 61% of new patients and 21% of previously treated patients were fully sensitive to all drugs. The most common resistance was streptomycin (27%) followed by isoniazid (23%) in new cases. Multiple drug resistant strains were noted in 2.6% (95% CI 0.8% to 5.8%) of new cases versus 56% (95% CI 43% to 68%) in previously treated group. The frequency of primary drug resistance to isoniazid was 9.8%-15% or streptomycin 9.8%-13% in the previous studies (p<0.00001). CONCLUSION: While these rates may not reflect the true prevalence of drug resistance on a national scale, it does partially demonstrate some defects in the existing tuberculosis control program. The significant increase of isoniazid and streptomycin resistance in the last few years would present a serious challenge to effective management of TB.