Biomechanically designed Curve Specific Corrective Exercise for Adolescent Idiopathic Scoliosis gives significant outcomes in an Adult: A case report.

Background: This study presents findings on improvements to the Frontal and Sagittal Cobb angle, Global Spinal balance, and lung function parameters (FEV1, PEF) in an adult male with idiopathic scoliosis suffering from pain during ADL and sports activities who was treated with a biomechanically designed exercise protocol. Case Presentation: The 26-year-old male reported upper and middle back pain which worsened when playing cricket. Whole spine standing x-Ray AP view revealed a right thoracic Scoliosis (Lenke 1 curve) of Cobb angle 48.6° with left lumbar compensatory curve of 24.7°, Thoracic hypo kyphosis of 9.9°, and VAS rating for pain of 8. The patient was treated with myofascial release, stretching, aerobics, strengthening exercises, "Breathing with core" for stabilization, and biomechanically designed curve specific corrective exercises. Results: Re-assessment 32 weeks post intervention demonstrated significant reduction in the major Cobb angle by 13.8°, minor Cobb angle by 9.5°, Thoracic hypokyphosis normalized to 37.8°, Coronal balance improved by 17.4 mm, Sagittal balance regained by 4.2 mm, Spine ROM improved by a total of 6.5 cm, Enhancement of pulmonary function of FEV1 by 7% and PEF by 18 litres/min, and dramatic improvement in aesthetics and pain perception. Conclusion: The biomechanically designed exercise protocol helped straighten the curve through curve specific corrective exercises and stabilized the curve by "Breathing with core". It also treated the associated signs and symptoms of spinal pain syndrome by myofascial release and proper ergonomics, pulmonary dysfunction by aerobics, and muscle tightness and weakness (due to altered length-tension) by stretching and strengthening.

Anti-Histone H3.3 G34W antibody is a sensitive and highly specific immunohistochemistry marker for the diagnosis of Giant cell tumor of bone. A validation based on analysis of 198 cases from a single centre in India.

Context: The diagnosis of giant cell tumor of bone (GCTB) is difficult in small biopsies with unusual age of presentation, location, and extensive secondary changes. Most of the GCTBs harbor H3F3A G34W mutations with a subset of cases showing alternate G34V, G34R, and G34L mutations. Objectives: To analyze the expression of anti-histone H3.3G34W antibody in different cellular components of GCTB across different locations and presentations (including the unusual ones) and validate the utility of this antibody in the diagnosis of GCTB and differentiate it from the other osteoclast-like giant-cell-rich lesions. Design: Immunohistochemistry was performed using anti-histone H3.3G34W antibody in the diagnosed cases of GCTB (136 cases of GCTB from 133 patients, including two malignant GCTBs) and other giant cell-containing lesions (62 cases). The presence of unequivocal crisp nuclear staining was considered positive. Results: Immunohistochemistry revealed unequivocal nuclear positivity in the mononuclear cells in 87.3% of the cases of GCTB. Of these, most showed diffuse expression with moderate to strong intensity staining. The positive staining was restricted to the nuclei of mononuclear cells with the nuclei of osteoclastic giant cells being distinctly negative. In addition to conventional GCTBs, two cases each of multicentric and malignant GCTB showed positive staining. The other giant-cell containing lesions were distinctly negative. The present study showed a sensitivity of 87.3% with specificity and positive predictive value of 100%. Conclusion: The anti-histone G34W antibody is a highly sensitive and specific marker for the diagnosis of GCTB and differentiating it from its mimics. The positive staining is restricted to the mononuclear cell component of GCTB with sparing the osteoclastic giant cells further reiterating the fact that the mononuclear stromal cells are the true neoplastic component of GCTB.