Petahertz charge dynamics in a correlated organic superconductor.

We report an observation of stimulated emission induced by a nearly single-cycle 6 fs near infrared electric field of 10 MV cm-1 in an organic superconductor (κ-(h-ET)2Cu[N(CN)2]Br). The stimulated emission is attributed to a non-linear synchronized coherent charge oscillation. We also report that, in the same organic superconductor, a light-induced current before the scattering time shows up as carrier-envelope phase (CEP)-sensitive second harmonic generation (SHG). This unconventional SHG in the centrosymmetric compound is regarded as a light induced spatial symmetry breaking. These ultrafast optical non-linearities induced by petahertz charge oscillations show anomalous enhancements around the superconducting transition temperature (11.6 K). These results indicate that the microscopic mechanism of superconducting fluctuations is closely related to the Coulomb repulsive interaction in this compound.

A novel EWSR1-VGLL1 gene fusion in a soft tissue malignant myoepithelial tumor.

Soft tissue myoepithelial tumors are very rare mesenchymal tumors that are currently categorized as miscellaneous neoplasms with uncertain differentiation. Although the molecular pathogenesis of soft tissue myoepithelial tumors remains unclear, EWSR1 gene fusions with a variety of partner genes are regarded as one of the major pathogenic driver events in these tumors. We herein present a case of a deep soft tissue malignant myoepithelial tumor arising in the thigh with multiple pulmonary metastases. This tumor displayed diverse and unique histological features, namely, an epithelioid glandular growth pattern, pseudorosette-like formation, and a diffuse nest and cord-like pattern within an abundant myxoid matrix. Next-generation RNA sequencing identified a novel fusion transcript, in which the in-frame junctional reads contained exon 9 of EWSR1 and exon 2 of VGLL1, resulting in the formation of a putative chimeric protein with the N-terminal transcriptional activation domain of EWSR1 and C-terminal full length of the VGLL1 protein. EWSR1-VGLL1 fusion has not been described in neoplasm before. Further molecular and functional experiments on the present EWSR1-VGLL1 fusion gene are required to elucidate its tumorigenic effect.

Gemcitabine and docetaxel combination chemotherapy for advanced bone and soft tissue sarcomas: protocol for an open-label, non-randomised, Phase 2 study.

BACKGROUND: The prognosis of patients with metastatic or advanced sarcomas is poor and there are few options for treatment. Several studies have shown that gemcitabine and docetaxel (GD) combination chemotherapy has antitumor activity against various subtypes of sarcoma. Recently, some studies have shown a favourable outcome for GD combination chemotherapy for relapsed high-grade osteosarcoma and spindle cell sarcoma of bone. If the effectiveness of GD is proven, this will result in new treatment options for advanced bone and soft tissue sarcomas (STS). The aim of this prospective Phase 2 study is to evaluate the efficacy and toxicity of the GD combination in patients with advanced bone sarcomas and STS. METHODS: This is a Phase 2, single-arm, open-label study to investigate the efficacy and safety of combination chemotherapy with GD for advanced bone sarcomas and STS and will enrol 20 patients. The patients will receive gemcitabine 900 mg/m2 on Days 1 and 8, and docetaxel 70 mg/m2 on Day 8 in 3-week cycles until disease progression or other evidence of treatment failure. The primary aim of this study is to analyse GD's effect on progression-free survival (PFS). The secondary objectives are to analyse treatment efficacy and safety in terms of response rate, tumour control rate, overall survival, and adverse event rate. The length of follow-up will be 5 years. DISCUSSION: This study will evaluate the efficacy and safety of combination therapy with gemcitabine and docetaxel for bone sarcomas and STS. If this combination proves to be acceptable, it could be used for as second, third, or later line therapy for patients with sarcomas (especially bone sarcomas). In the future, the role of various treatments, including GD therapy, will be clarified for specific subtypes of sarcoma. TRIAL REGISTRATION: This study was registered as UMIN000031004 (University Hospital Medical Information Network-Clinical Trial Registry: UMIN-CTR) on 1 March 1 2018 and with the Japan Registry of Clinical Trials (jRCT) as jRCTs051180042 on 30 January 2019. The posted information will be updated as needed to reflect protocol amendments and study progress.

Serum and nutrient deprivation increase autophagic flux in intervertebral disc annulus fibrosus cells: an in vitro experimental study.

PURPOSE: The loss of nutrient supply is a suspected contributor of intervertebral disc degeneration. However, the extent to which low nutrition affects disc annulus fibrosus (AF) cells is unknown as nutrient deprivation has mainly been investigated in disc nucleus pulposus cells. Hence, an experimental study was designed to clarify the effects of limited nutrients on disc AF cell fate, including autophagy, the process by which cells recycle their own damaged components. METHODS: Rabbit disc AF cells were cultured in different media with varying serum concentrations under 5% oxygen. Cellular responses to changes in serum and nutrient concentrations were determined by measuring proliferation and metabolic activity. Autophagic flux in AF cells was longitudinally monitored using imaging cytometry and Western blotting for LC3, HMGB1, and p62/SQSTM1. Apoptosis (TUNEL staining and cleaved caspase-3 immunodetection) and cellular senescence (senescence-associated ß-galactosidase assay and p16/INK4A immunodetection) were measured. RESULTS: Markers of apoptosis and senescence increased, while cell proliferation and metabolic activity decreased under the withdrawal of serum and of nutrients other than oxygen, confirming cellular stress. Time-dependent increases in autophagy markers, including LC3 puncta number per cell, LC3-II expression, and cytoplasmic HMGB1, were observed under conditions of reduced nutrition, while an autophagy substrate, p62/SQSTM1, decreased over time. Collectively, these findings suggest increased autophagic flux in disc AF cells under serum and nutrient deprivation. CONCLUSION: Disc AF cells exhibit distinct responses to serum and nutrient deprivation. Cellular responses include cell death and quiescence in addition to reduced proliferation and metabolic activity, as well as activation of autophagy under conditions of nutritional stress. These slides can be retrieved under Electronic Supplementary Material.

Tissue engineering of ligaments for reconstructive surgery.

PURPOSE: The use of musculoskeletal bioengineering and regenerative medicine applications in orthopaedic surgery has continued to evolve. The aim of this systematic review was to address tissue-engineering strategies for knee ligament reconstruction. METHODS: A systematic review of PubMed/Medline using the terms "knee AND ligament" AND "tissue engineering" OR "regenerative medicine" was performed. Two authors performed the search, independently assessed the studies for inclusion, and extracted the data for inclusion in the review. Both preclinical and clinical studies were reviewed, and the articles deemed most relevant were included in this article to provide relevant basic science and recent clinical translational knowledge concerning "tissue-engineering" strategies currently used in knee ligament reconstruction. RESULTS: A total of 224 articles were reviewed in our initial PubMed search. Non-English-language studies were excluded. Clinical and preclinical studies were identified, and those with a focus on knee ligament tissue-engineering strategies including stem cell-based therapies, growth factor administration, hybrid biomaterial, and scaffold development, as well as mechanical stimulation modalities, were reviewed. CONCLUSIONS: The body of knowledge surrounding tissue-engineering strategies for ligament reconstruction continues to expand. Presently, various tissue-engineering techniques have some potential advantages, including faster recovery, better ligamentization, and possibly, a reduction of recurrence. Preclinical research of these novel therapies continues to provide promising results. There remains a need for well-designed, high-powered comparative clinical studies to serve as a foundation for successful translation into the clinical setting going forward. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.

Bilateral medial patellofemoral ligament reconstruction in high-level athletes.

This report presents two cases of high-level athletes with bilateral patellar dislocations who were able to return to their preinjury level of activity after bilateral medial patellofemoral ligament (MPFL) reconstruction, without any major complications. Patient 1 was a 19-year-old male volleyball player for a top-level college volleyball team, and patient 2 was a 24-year-old woman who was a member of a national-level adult softball team. MPFL reconstruction could be an effective treatment for bilateral patellar dislocation in high-level athletes. Level of evidence V.

Tibial internal rotation is affected by lateral laxity in cruciate-retaining total knee arthroplasty: an intraoperative kinematic study using a navigation system and offset-type tensor.

PURPOSE: The purpose of this study was to test the hypothesis that intraoperative soft-tissue balance assessed by an offset-type tensor influences post-operative knee kinematics after cruciate-retaining (CR) total knee arthroplasty (TKA). METHODS: The influence of intraoperative soft-tissue balance on knee kinematics in CR-TKA was retrospectively analysed in 30 patients. Intraoperative soft-tissue balance parameters such as varus angle (varus ligament balance), joint component gap (centre gap), and medial and lateral compartment gaps were measured in the navigation system while applying 40-lb joint distraction force at 0°, 10°, 30°, 60°, 90°, and 120° of knee flexion using an offset-type tensor with the patella reduced. Tibial internal rotation and tibial anterior translation were measured as the differences between the values at 60° and 120° of flexion using the navigation system. Correlations between the soft-tissue parameters and post-operative knee kinematics were analysed. RESULTS: The varus ligament balance was positively correlated with tibial internal rotation at 60° and 90° of flexion (R = 0.54, P < 0.05; R = 0.60, P < 0.01, respectively). Furthermore, the joint component gap was positively correlated with tibial internal rotation at 90° of flexion (R = 0.44, P < 0.05), and the lateral compartment gap was positively correlated with tibial internal rotation at 60°, 90°, and 120° of knee flexion. CONCLUSIONS: The intraoperative varus ligament balance and joint component gap values were factors that predicted post-operative knee kinematics after CR-TKA. Lateral laxity at mid-to-deep knee flexion plays a significant role in tibial internal rotation. LEVEL OF EVIDENCE: III.

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique.

PURPOSE: The purpose of this study was to prove the hypothesis that soft tissues are well balanced using the gap technique with a navigation system in cruciate-retaining (CR) and posterior-stabilised (PS) total knee arthroplasty (TKA), leading to better clinical outcomes compared with the measured-resection technique. METHODS: One hundred and thirty-five TKAs (90 CR and 45 PS) were performed in patients with varus-type osteoarthritis using the gap technique guided by the offset-type tensor and a navigation system. Soft-tissue balance (joint-component gap and ligament balance) were intraoperatively assessed with the tensor under 40 lb of joint-distraction force. The achievement in the equalised rectangular gap at extension and flexion was assessed and retrospectively compared with the previous series in which the measured-resection technique was used (20 CR and 100 PS TKAs). In addition, clinical outcomes, including range of motion and Knee Society Score were assessed at a minimum two year follow-up. RESULTS: In achieving equalised rectangular gaps at extension and flexion, CR TKAs met criteria in more cases [66.7% (64/90) vs. 44.4% (20/45) of PS TKA] with the gap technique, which was superior to that with the measured-resection technique [50.0% (10/20) of CR TKA and 28.0% (28/100) of PS TKA]. However, clinical outcomes showed no significant differences among groups at minimum two year follow-up. CONCLUSIONS: The superiority of CR TKA with the gap technique in achieving equalised rectangular gaps at extension and flexion does not directly reflect two year postoperative clinical outcomes.

A small interfering RNA targeting Lnk accelerates bone fracture healing with early neovascularization.

Lnk, an intracellular adapter protein, is expressed in hematopoietic cell lineages, which has recently been proved as an essential inhibitory signaling molecule for stem cell self-renewal in the stem cell factor-c-Kit signaling pathway with enhanced hematopoietic and osteogenic reconstitution in Lnk-deficient mice. Moreover, the therapeutic potential of hematopoietic stem/endothelial progenitor cells (EPCs) for fracture healing has been demonstrated with mechanistic insight into vasculogenesis/angiogenesis and osteogenesis enhancement in the fracture sites. We report here, Lnk siRNA-transfected endothelial commitment of c-kit+/Sca-1+/lineage- subpopulations of bone marrow cells have high EPC colony-forming capacity exhibiting endothelial markers, VE-Cad, VEGF and Ang-1. Lnk siRNA-transfected osteoblasts also show highly osteoblastic capacity. In vivo, locally transfected Lnk siRNA could successfully downregulate the expression of Lnk at the fracture site up to 1 week, and radiological and histological examination showed extremely accelerated fracture healing in Lnk siRNA-transfected mice. Moreover, Lnk siRNA-transfected mice exhibited sufficient therapeutic outcomes with intrinstic enhancement of angiogenesis and osteogenesis, specifically, the mice demonstrated better blood flow recovery in the sites of fracture. In our series of experiments, we clarified that a negatively regulated Lnk system contributed to a favorable circumstance for fracture healing by enhancing vasculogenesis/angiogenesis and osteogenesis. These findings suggest that downregulation of Lnk system may have the clinical potential for faster fracture healing, which contributes to the reduction of delayed unions or non-unions.

Different pattern in gap balancing between the cruciate-retaining and posterior-stabilized total knee arthroplasty.

PURPOSE: In order to permit soft tissue balance under more physiological conditions during total knee arthroplasties (TKAs), an offset-type tensor was developed to obtain soft tissue balancing throughout the range of motion with reduced patello-femoral (PF) and aligned tibiofemoral joints. The main purpose of the present study was to assess intra-operative soft tissue balance using a navigation system with the offset-type tensor in both cruciate-retaining (CR) and posterior-stabilized (PS) TKAs. METHODS: One hundred and twenty TKAs--80 CR and 40 PS--were performed in patients with varus-type osteoarthritis using a computed tomography-free navigation system. The offset-type TKA tensor with a reduced and repaired PF joint and femoral component in place was used with the tibia first gap technique to balance soft tissues (joint component gap and ligament balance) at 0°, 10°, 30°, 60°, 90°, and 120° of flexion. The achievement in equalized rectangular gap at extension and flexion--joint component gap within ±3 mm between extension and flexion and ligament balance within ±3° at extension and flexion--was assessed retrospectively. RESULTS: Both types of implants showed similar patterns of soft tissue balance throughout the range of motion, whereas PS TKA had larger values especially at 60° or 90° of flexion than did CR TKA. In the achievement of equalized rectangular gaps at extension and flexion, CR TKA was superior to PS TKA. CONCLUSION: Using the tibia first gap technique with the tensor allows appropriate soft tissue balancing, especially in CR TKA. LEVEL OF EVIDENCE: Therapeutic studies, Level II.

Kinematic factors affecting postoperative knee flexion after cruciate-retaining total knee arthroplasty.

PURPOSE: The purpose of this study was to investigate kinematic factors affecting postoperative knee flexion after cruciate-retaining (CR) total knee arthroplasty (TKA) by analysing pre- and postoperative knee kinematics. METHODS: We retrospectively analysed 58 patients with osteoarthritis who received the same implant series. Pre- and postoperative kinematics were measured intraoperatively using a navigation system. As a clinical outcome, we measured the knee flexion angle before and one year after surgery. Correlations among pre- and postoperative kinematics and postoperative flexion were analysed using simple linear regression analyses. RESULTS: Preoperative knee kinematics, including tibial internal rotation and anterior translation (R = 0.87, P < 0.001; R = 0.53, P < 0.001, respectively), were significantly correlated with postoperative kinematics. Preoperative varus-valgus movements improved significantly postoperatively; however, tibial internal rotation remained unchanged. Furthermore, postoperative knee flexion angle was significantly correlated with postoperative tibial internal rotation (R = 0.45, P < 0.001). CONCLUSIONS: Preoperative knee kinematics were unchanged even after CR-TKA. Postoperative tibial internal rotation is one of the most important factors affecting postoperative knee flexion.

The Senolytic Drug Fisetin Attenuates Bone Degeneration in the Zmpste24 -/- Progeria Mouse Model.

Aging leads to several geriatric conditions including osteoporosis (OP) and associated frailty syndrome. Treatments for these conditions are limited and none target fundamental drivers of pathology, and thus identifying strategies to delay progressive loss of tissue homeostasis and functional reserve will significantly improve quality of life in elderly individuals. A fundamental property of aging is the accumulation of senescent cells. Senescence is a cell state defined by loss of proliferative capacity, resistance to apoptosis, and the release of a proinflammatory and anti-regenerative senescence-associated secretory phenotype (SASP). The accumulation of senescent cells and SASP factors is thought to significantly contribute to systemic aging. Senolytics-compounds which selectively target and kill senescent cells-have been characterized to target and inhibit anti-apoptotic pathways that are upregulated during senescence, which can elicit apoptosis in senescent cells and relieve SASP production. Senescent cells have been linked to several age-related pathologies including bone density loss and osteoarthritis in mice. Previous studies in murine models of OP have demonstrated that targeting senescent cells pharmacologically with senolytic drugs can reduce symptomology of the disease. Here, we demonstrate the efficacy of senolytic drugs (dasatinib, quercetin, and fisetin) to improve age-associated degeneration in bone using the Zmpste24-/- (Z24-/-) progeria murine system for Hutchinson-Gilford progeria syndrome (HGPS). We found that the combination of dasatinib plus quercetin could not significantly mitigate trabecular bone loss although fisetin administration could reduce bone density loss in the accelerated aging Z24-/- model. Furthermore, the overt bone density loss observed in the Z24-/- model reported herein highlights the Z24 model as a translational model to recapitulate alterations in bone density associated with advanced age. Consistent with the "geroscience hypothesis," these data demonstrate the utility of targeting a fundamental driver of systemic aging (senescent cell accumulation) to alleviate a common condition with age, bone deterioration.

The accuracy of bone tunnel position using fluoroscopic-based navigation system in anterior cruciate ligament reconstruction.

PURPOSE: The first purpose of this study was to examine whether fluoroscopic-based navigation system contributes to the accuracy and reproducibility of the bone tunnel placements in single-bundle anterior cruciate ligament (ACL) reconstruction. The second purpose was to investigate the application of the navigation system for double-bundle ACL reconstruction. METHODS: A hospital-based case-control study was conducted, including a consecutive series of 55 patients. In 37 patients who received single-bundle ACL reconstruction, surgeries were performed with this system for 19 knees (group 1) and without this system for 18 knees (group 2). The positioning of the femoral and tibial tunnels was evaluated by plain sagittal radiographs. In 18 patients who received double-bundle ACL reconstruction using the navigation system (group 3), the bone tunnel positions were assessed by three-dimensional computed tomography (3D-CT). Clinical assessment of all patients was followed with the use of Lysholm Knees Score and IKDC. RESULTS: Taking 0% as the anterior and 100% as the posterior extent, the femoral tunnels were 74.9 ± 3.0% in group 1 and 71.5 ± 5.8% in group 2 along Blumensaat's line, and the tibial tunnels were 42.3 ± 1.4% in group 1 and 42.5 ± 4.6% in group 2 along the tibia plateau. The bone tunnel positions in group 1 were located significantly closer to the position planned preoperatively and varied less in both femur and tibial side, compared with those without navigation (group 2). (Femur: P < 0.05, Tibia: P < 0.001) 3D-CT evaluation of double-bundle ACL reconstruction (group 3) also demonstrated that the bone tunnel positions of both anteromedial (AM) and posterolateral (PL) were placed as we expected. CONCLUSION: The fluoroscopic-based navigation system contributed to the more reproducible placement of the bone tunnel during single-bundle ACL reconstruction compared with conventional technique. Additionally, this device was also useful for double-bundle ACL reconstruction. LEVEL OF EVIDENCE: Case-control study, Therapeutic study, Level III.

Regulatory roles of miRNAs 16, 133a, and 223 on osteoclastic bone destruction caused by breast cancer metastasis.

Osteolytic bone metastasis leads to skeletal­related events, resulting in a decline in the patient activities and survival; therefore, it is important to understand the mechanism underlying bone metastasis. Recent studies have suggested that microRNAs (miRNAs or miRs) are involved in osteoclast differentiation and/or osteolytic bone metastasis; however, the roles of miRNAs have not been elucidated. In the present study, the roles of miRNAs in bone destruction caused by breast cancer metastasis were investigated in vitro and in vivo. miR­16, miR­133a and miR­223 were transfected into a human breast cancer cell line, MDA­MB­231. The expression of osteolytic factors in conditioned medium (miR­CM) collected from the culture of transfected cells was assessed. To evaluate the effects of miRNAs on osteoclast differentiation and activities, tartrate­resistant acid phosphatase (TRAP) staining and bone resorptive assays were performed in osteoclasts following miR­CM treatment. To create in vivo bone metastasis models for histological and morphometric evaluation, miRNA­transfected MDA­MB­231 cells were transplanted into the proximal tibia of nude mice. Expression of osteolytic factors, including receptor activator for nuclear factor­κB ligand (RANKL), interleukin (IL)­1ß, IL­6, parathyroid hormone­related protein (PTHrP), and tumor necrosis factor (TNF), was increased in miR­16­CM, whereas it was decreased in both miR­133a­CM and miR­223­CM. TRAP staining and bone resorptive assays revealed that osteoclast function and activities were promoted by miR­16­CM treatment, whereas they were suppressed by miR­133a­CM and miR­223­CM. Consistent with in vitro findings, in vivo experiments revealed that the overexpression of miR­16 increased osteoclast activities and bone destruction in MDA­MB­231 cells, whereas the opposite results were observed in both miR­133a­ and miR­223­transfected MDA­MB­231 cells. Our results indicated that miR­16 promoted osteoclast activities and bone destruction caused by breast cancer metastasis in the bone microenvironment, whereas miR­133a and miR­223 suppressed them. These miRNAs could be potential biomarkers and therapeutic targets for breast cancer bone metastasis.

Chondrolipoma of the finger in a child: A case study.

Chondrolipoma is, based on the limited case reports available, an extremely rare histological variant of lipoma with the proliferation of mature adipocytes containing an area of true hyaline cartilage. Chondrolipoma is characterized by adult onset and is often identified in the breast, pharynx and tongue. The current study presents a case of chondrolipoma of the finger in an 11 year-old girl. Physical examination indicated a well-defined elastic soft mass, measuring 2.5x2 cm, on the dorsal aspect of the proximal phalanx of the left middle finger. Magnetic resonance imaging (MRI) revealed a well-circumscribed lesion with heterogeneous signal intensity. On T1- and T2-weighted images, the lesion indicated a predominantly marked hyperintense signal containing linear hypointense regions, and on fat-suppressed short-tau inversion recovery sequences, the lesion indicated a predominant hypointensity, with linear regions displaying hyperintensity. Marginal excision of the tumor was performed. Histologically, the major component of the tumor was mature adipose tissue containing a limited area of mature hyaline cartilage matrix, without lipoblasts or malignancy. The postoperative course of the patient was excellent, with no local recurrence three years after surgery. To the best of our knowledge, the current study outlines the first pediatric case of chondrolipoma arising in the finger.

Clinical Outcome of the Patients With Brain Metastasis from Soft Tissue Sarcomas.

BACKGROUND/AIM: This study aimed to evaluate the association of clinical characteristics with treatment outcomes to ascertain the appropriate treatment options for soft tissue sarcomas (STS) patients with brain metastasis (BM). PATIENTS AND METHODS: Medical records of STS patients with BM who were treated in our institutions were retrospectively reviewed, and analyzed to identify the factors associated with post-BM survival. RESULTS: Among the 509 STS patients, BM occurred in five patients (0.98%). The median survival after BM was 1.5 months. Histological subtypes of the primary lesions in the five BM patients were: two synovial sarcomas, one myxoid liposarcoma, one alveolar soft part sarcoma, and one rhabdomyosarcoma. Among the five BM patients, the post-BM survival of two patients, who underwent surgery and postoperative radiotherapy, was longer than that of the other patients (p<0.01). CONCLUSION: Combined surgery and postoperative radiotherapy effectively managed symptoms and prolonged survival in STS patients with BM.

A Cell-free Biodegradable Synthetic Artificial Ligament for the Reconstruction of Anterior Cruciate Ligament in a Rat Model.

Traditional Anterior Cruciate Ligament (ACL) reconstruction is commonly performed using an allograft or autograft and possesses limitations such as donor site morbidity, decreased range of motion, and potential infection. However, a biodegradable synthetic graft could greatly assist in the prevention of such restrictions after ACL reconstruction. In this study, artificial grafts were generated using "wet" and "dry" electrospinning processes with a biodegradable elastomer, poly (ester urethane) urea (PEUU), and were evaluated in vitro and in vivo in a rat model. Four groups were established: (1) Wet PEUU artificial ligament, (2) Dry PEUU artificial ligament, (3) Dry polycaprolactone artificial ligament (PCL), and (4) autologous flexor digitorum longus tendon graft. Eight weeks after surgery, the in vivo tensile strength of wet PEUU ligaments had significantly increased compared to the other synthetic ligaments. These results aligned with increased infiltration of host cells and decreased inflammation within the wet PEUU grafts. In contrast, very little cellular infiltration was observed in PCL and dry PEUU grafts. Micro-computed tomography analysis performed at 4 and 8 weeks postoperatively revealed significantly smaller bone tunnels in the tendon autograft and wet PEUU groups. The Wet PEUU grafts served as an adequate functioning material and allowed for the creation of tissues that closely resembled the ACL.

BNCT for primary synovial sarcoma.

Synovial sarcoma is a rare tumor requiring new treatment methods. A 46-year-old woman with primary monophasic synovial sarcoma in the left thigh involving the sciatic nerve, declining surgery because of potential dysfunction of the affected limbs, received two courses of BNCT. The tumor thus reduced was completely resected with no subsequent recurrence. The patient is now able to walk unassisted, and no local recurrence has been observed, demonstrating the applicability of BNCT as adjuvant therapy for synovial sarcoma. Further study and analysis with more experience accumulation are needed to confirm the real impact of BNCT efficacy for its application to synovial sarcoma.

Surgical outcomes of metastatic bone tumors in the extremities (Surgical outcomes of bone metastases).

BACKGROUND: Skeletal related events due to metastatic bone tumors markedly affect the activities of daily living (ADL) and quality of life (QOL) in cancer patients. We focused on multidisciplinary therapy for metastatic bone tumors. This study aimed to evaluate the outcomes of surgical treatment for metastatic bone tumors in the extremities. METHODS: We retrospectively reviewed 114 patients who underwent surgical treatment for metastatic bone tumors of the extremities between 2008 and 2019 and 69 patients were reassessed for more than 6 months after surgery. The most common primary tumor was renal, followed by lung, thyroid, and breast cancers. We assessed 69 patients' performance status (PS), Barthel Index (BI) for ADL, EuroQol 5 Dimensions (EQ-5D) for QOL, and numerical rating scale (NRS) for pain and analyzed these postoperative values relative to preoperative values using Friedman's test. The postoperative overall survival and the prognostic factors were evaluated using the Kaplan-Meier method, the log-rank test and Cox proportional hazards analysis. RESULTS: The 1-year overall survival rate was 59%, and the median survival time after surgery was 20 months. Primary tumor, visceral metastasis, and surgical procedure were risk factors correlated with overall survival. PS, BI, EQ-5D, and NRS improved at 3 months after surgery and these improvements were maintained for 6 months after surgery regardless of the surgical procedure. CONCLUSIONS: The significant factors affecting survival after surgical treatment for bone metastases included the primary tumor, presence of visceral metastases, and internal fixation without tumor resection or curettage. Surgical treatment for metastatic bone tumors effectively reduced pain and improved PS, ADL, and QOL postoperatively after 3 months.

Extraskeletal Para-articular Osteochondroma of the Ankle Joint in a Child: A Case Report.

CASE: We present a rare case of extraskeletal para-articular osteochondroma (ESPAOC) in the ankle of a 9-year-old boy, which was causing pain and limiting the range of motion of the ankle joint. The lesion might have also contributed to the deformity of the medial aspect of the talus. Total resection resolved all of the symptoms, with no recurrence at 1-year postoperatively. CONCLUSION: Operative excision should be considered when ESPAOC directly restricts ankle motion because it can lead to chronic pain and joint degeneration if left untreated.