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Plastic and Reconstructive Surgery.... Apr 2024Surgeons face challenges associated with adherent cutaneous scalp malignancy. Traditional general anesthetic excision involves periosteal removal and burring of the...
BACKGROUND
Surgeons face challenges associated with adherent cutaneous scalp malignancy. Traditional general anesthetic excision involves periosteal removal and burring of the outer table of the calvaria for deep margin clarity and tissue reconstruction. Research on this practice is limited, and graft survival in burr-treated bones is underexplored. This study aimed to assess the clinical margin accuracy for immobile scalp malignancies, identify deep-invading malignancy types, and evaluate graft survival in burr-treated calvariae. It compares split-thickness grafts (STSGs) and full-thickness grafts (FTSGs).
METHODS
Twelve fixed scalp malignancies were excised under anesthesia, allowing immediate STSG or FTSG for defect reconstruction. Postsurgery, graft take, malignancy type, and margin clearance were evaluated.
RESULTS
Histopathological diagnosis identified seven squamous cell carcinomas, two melanomas, one basal cell carcinoma, one adenocarcinoma, and one metastatic squamous cell carcinoma. Deep margins ranged from 0 to 0.9 mm, and peripheral margins ranged from 0 to 15 mm. The graft take was 100% in eight cases, with total failure in two cases, and 75%-90% in two cases. The five STSGs had 100% take and 90% take. The three FTSGs had 100%, 75%, and two failed.
CONCLUSIONS
Clinical examination effectively gauges the tumor fixation depth, but large lesions may require imaging. Most deep-invading tumors were SCCs. STSGs performed better on burr-treated Calvaria than FTSGs.
PubMed: 38645628
DOI: 10.1097/GOX.0000000000005757 -
Cellular & Molecular Biology Letters Apr 2024During growth phase, antlers exhibit a very rapid rate of chondrogenesis. The antler is formed from its growth center reserve mesenchyme (RM) cells, which have been...
During growth phase, antlers exhibit a very rapid rate of chondrogenesis. The antler is formed from its growth center reserve mesenchyme (RM) cells, which have been found to be the derivatives of paired related homeobox 1 (Prrx1)-positive periosteal cells. However, the underlying mechanism that drives rapid chondrogenesis is not known. Herein, the miRNA expression profiles and chromatin states of three tissue layers (RM, precartilage, and cartilage) at different stages of differentiation within the antler growth center were analyzed by RNA-sequencing and ATAC-sequencing. We found that miR-140-3p was the miRNA that exhibited the greatest degree of upregulation in the rapidly growing antler, increasing from the RM to the cartilage layer. We also showed that Prrx1 was a key upstream regulator of miR-140-3p, which firmly confirmed by Prrx1 CUT&Tag sequencing of RM cells. Through multiple approaches (three-dimensional chondrogenic culture and xenogeneic antler model), we demonstrated that Prrx1 and miR-140-3p functioned as reciprocal negative feedback in the antler growth center, and downregulating PRRX1/upregulating miR-140-3p promoted rapid chondrogenesis of RM cells and xenogeneic antler. Thus, we conclude that the reciprocal negative feedback between Prrx1 and miR-140-3p is essential for balancing mesenchymal proliferation and chondrogenic differentiation in the regenerating antler. We further propose that the mechanism underlying chondrogenesis in the regenerating antler would provide a reference for helping understand the regulation of human cartilage regeneration and repair.
Topics: Animals; Antlers; Cartilage; Cell Differentiation; Chondrogenesis; Homeodomain Proteins; MicroRNAs
PubMed: 38643083
DOI: 10.1186/s11658-024-00573-x -
Seminars in Arthritis and Rheumatism Aug 2024Enthesitis is a cardinal feature of spondylarthritis (SpA), and the pelvis is a common site of enthesitis. This study aimed to establish the association between pelvic...
INTRODUCTION/OBJECTIVES
Enthesitis is a cardinal feature of spondylarthritis (SpA), and the pelvis is a common site of enthesitis. This study aimed to establish the association between pelvic enthesis involvement on pelvic X-ray and SpA diagnosis through a radiographic enthesis index (REI) and to assess the reliability and accuracy of this REI.
MATERIALS AND METHODS
The participants were SpA patients and a control group composed of patients with chronic lumbar pain without SpA. Three blinded observers assessed each pelvic radiography three times. Three zones were used: Zone I (ZI), the iliopubic ramus; Zone II (ZII), the pubic symphysis, and Zone III (ZIII), the ischiopubic ramus. A grading system was created from 0 to 3 [Grade 0, normal; Grade 1, minimal changes (subcortical bone demineralization and/or periosteal wishkering, seen as radiolucency and trabeculation of the cortical bone upon tendon insertion); Grade 2, destructive changes (Grade 1 findings and erosions at the enthesis site); and Grade 3, findings of Grade 2 plus >2 mm whiskering out of the cortical bone) for the REI. The sum of the results of the three zones was called the total REI. For statistical analysis, we used the weighted kappa statistic adjusted for prevalence and bias using Gwet's agreement coefficient.
RESULTS
We enrolled 161 patients, 111 of them with SpA (39.6 % with axial SpA and 47.7 % with peripheral SpA) and 50 without SpA. In the SpA group, 36.7 % and 25.7 % had REI Grades 2 and 3 in ZIII, respectively, while only 6 % of the controls had these grades. For ZI, the frequency of Grades 1 to 3 was 42.3 % in the SpA group (8.1 %, 14.4 %, and 19.8 %, respectively), compared to only 2 % in the controls. ZII was unaffected in most of the patients with SpA (82.9 %) and in the controls (98 %). In the control group, Grade 0 was the most common REI grade in all three zones. The agreement was almost perfect for each zone and between the independent readers. The ROC-curve analysis showed that the highest performance areas were the total REI, ZIII, and ZI. Most (75 %) of the SpA patients without sacroiliitis on X-ray were REI-positive. The sensitivity of the REI for SpA diagnosis was 82 %, while the sensitivity of sacroiliitis on X-ray was 38.7 %.
CONCLUSIONS
The assessment of pelvic enthesis using the REI on pelvic radiography may be useful for SpA diagnosis. Total REI, ZIII, and ZI had the highest accuracy and almost perfect reliability. The REI is especially helpful in patients without sacroiliitis on imaging.
Topics: Humans; Enthesopathy; Female; Male; Spondylarthritis; Adult; Sacroiliitis; Radiography; Middle Aged; Reproducibility of Results; Pelvis; Severity of Illness Index; Pelvic Bones
PubMed: 38642418
DOI: 10.1016/j.semarthrit.2024.152435 -
The Journal of Craniofacial Surgery Jun 2024Case report. Osteoradionecrosis (ORN) of the jaw is a potentially devastating consequence of head and neck irradiation. The progression of ORN can lead to loss of bone,...
Case report. Osteoradionecrosis (ORN) of the jaw is a potentially devastating consequence of head and neck irradiation. The progression of ORN can lead to loss of bone, teeth, soft tissue necrosis, pathologic fracture, and oro-cutaneous fistula. Reconstructive surgery has mostly been reserved for late-stage disease where segmental resections are frequently necessary. Evidence is emerging to support earlier treatment in the form of debridement in combination with soft tissue free flaps for intermediate-stage ORN. The authors present a case of a 76-year-old male with persistent Notani 2 ORN of the mandible, treated with surgical removal of all remaining mandibular teeth, transoral debridement of all necrotic mandibular bone, and bone coverage with a left medial femoral condyle (MFC) periosteal free flap based on the descending genicular artery. Treatment was uneventful both intraoperatively and postoperatively. Since surgery (15 mo) the patient has remained free from clinical and radiologic signs of ORN. The MFP periosteal free flap provided an excellent result with minimal surgical complexity and morbidity in this case. Such treatment at an intermediate stage likely results in a reduction in segmental resections, less donor site morbidity, less operative time, less overall treatment time, and possibly fewer postoperative complications compared with the status quo.
Topics: Humans; Male; Osteoradionecrosis; Aged; Debridement; Free Tissue Flaps; Femur; Mandibular Diseases; Periosteum; Plastic Surgery Procedures; Tooth Extraction
PubMed: 38635500
DOI: 10.1097/SCS.0000000000010059 -
Science Translational Medicine Apr 2024Traumatic brain injury (TBI) leads to skeletal changes, including bone loss in the unfractured skeleton, and paradoxically accelerates healing of bone fractures;...
Traumatic brain injury (TBI) leads to skeletal changes, including bone loss in the unfractured skeleton, and paradoxically accelerates healing of bone fractures; however, the mechanisms remain unclear. TBI is associated with a hyperadrenergic state characterized by increased norepinephrine release. Here, we identified the β-adrenergic receptor (ADRB2) as a mediator of skeletal changes in response to increased norepinephrine. In a murine model of femoral osteotomy combined with cortical impact brain injury, TBI was associated with ADRB2-dependent enhanced fracture healing compared with osteotomy alone. In the unfractured 12-week-old mouse skeleton, ADRB2 was required for TBI-induced decrease in bone formation and increased bone resorption. Adult 30-week-old mice had higher bone concentrations of norepinephrine, and ADRB2 expression was associated with decreased bone volume in the unfractured skeleton and better fracture healing in the injured skeleton. Norepinephrine stimulated expression of vascular endothelial growth factor A and calcitonin gene-related peptide-α (αCGRP) in periosteal cells through ADRB2, promoting formation of osteogenic type-H vessels in the fracture callus. Both ADRB2 and αCGRP were required for the beneficial effect of TBI on bone repair. Adult mice deficient in ADRB2 without TBI developed fracture nonunion despite high bone formation in uninjured bone. Blocking ADRB2 with propranolol impaired fracture healing in mice, whereas the ADRB2 agonist formoterol promoted fracture healing by regulating callus neovascularization. A retrospective cohort analysis of 72 patients with long bone fractures indicated improved callus formation in 36 patients treated with intravenous norepinephrine. These findings suggest that ADRB2 is a potential therapeutic target for promoting bone healing.
Topics: Humans; Animals; Mice; Fracture Healing; Vascular Endothelial Growth Factor A; Adrenergic Agents; Retrospective Studies; Fractures, Bone; Brain Injuries, Traumatic; Neovascularization, Pathologic; Norepinephrine
PubMed: 38630849
DOI: 10.1126/scitranslmed.adk9129 -
ACS Applied Materials & Interfaces Apr 2024The periosteum, rich in neurovascular networks, bone progenitor cells, and stem cells, is vital for bone repair. Current artificial periosteal materials face challenges...
The periosteum, rich in neurovascular networks, bone progenitor cells, and stem cells, is vital for bone repair. Current artificial periosteal materials face challenges in mechanical strength, bacterial infection, and promoting osteogenic differentiation and angiogenesis. To address these issues, we adjusted the electrospinning ratio of poly-ε-caprolactone and chitosan and incorporated Zn doping whitlockite with polydopamine coating into a nanofiber membrane. After a series of characterizations, optimal results were achieved with a poly-ε-caprolactone: chitosan ratio of 8:1 and 5% nanoparticle content. In vitro cell experiments and in vivo calvarial defect models, the sustained release of Mg and Ca promoted vascularization and new bone formation, respectively, while the release of Zn was conducive to antibacterial and cooperated with Mg to promote neurovascularization. Consequently, this antibacterial bionic periosteum with an angiogenesis-neurogenesis coupling effect demonstrates a promising potential for bone repair applications.
PubMed: 38623938
DOI: 10.1021/acsami.4c01206 -
PeerJ 2024Very large unidentified elongate and rounded fossil bone segments of uncertain origin recovered from different Rhaetian (Late Triassic) fossil localities across Europe...
Very large unidentified elongate and rounded fossil bone segments of uncertain origin recovered from different Rhaetian (Late Triassic) fossil localities across Europe have been puzzling the paleontological community since the second half of the 19th century. Different hypotheses have been proposed regarding the nature of these fossils: (1) giant amphibian bones, (2) dinosaurian or other archosaurian long bone shafts, and (3) giant ichthyosaurian jaw bone segments. We call the latter proposal the 'Giant Ichthyosaur Hypothesis' and test it using bone histology. In presumable ichthyosaur specimens from SW England (Lilstock), France (Autun), and indeterminate cortical fragments from Germany (Bonenburg), we found a combination of shared histological features in the periosteal cortex: an unusual woven-parallel complex of strictly longitudinal primary osteons set in a novel woven-fibered matrix type with intrinsic coarse collagen fibers (IFM), and a distinctive pattern of Haversian substitution in which secondary osteons often form within primary ones. The splenial and surangular of the holotype of the giant ichthyosaur from Canada were sampled for comparison. The results of the sampling indicate a common osteohistology with the European specimens. A broad histological comparison is provided to reject alternative taxonomic affinities aside from ichthyosaurs of the very large bone segment. Most importantly, we highlight the occurrence of shared peculiar osteogenic processes in Late Triassic giant ichthyosaurs, reflecting special ossification strategies enabling fast growth and achievement of giant size and/or related to biomechanical properties akin to ossified tendons.
Topics: Animals; Dinosaurs; Osteogenesis; Diaphyses; Canada; England
PubMed: 38618574
DOI: 10.7717/peerj.17060 -
Trauma Case Reports Jun 2024Diaphyseal forearm fractures are typically treated with open reduction and plate fixation, which has been proven to be the most effective method in numerous trials....
Diaphyseal forearm fractures are typically treated with open reduction and plate fixation, which has been proven to be the most effective method in numerous trials. However, the risk of periosteal stripping, haemorrhage evacuation, nonunion, and infection is always present and may cause a delayed union and other surgical consequences. Although intramedullary nails have been mentioned in the literature for forearm bone fractures, issues regarding their common complication of nail migration, especially of the ulnar fracture, before the fracture has been consolidated is an issue, and has not been addressed. We describe a case of IM nail migration of Ulna who presented to us, during the follow up, before the fracture had consolidated. The procedure described is short and consistent with the outstanding cosmetic and functional results.
PubMed: 38618149
DOI: 10.1016/j.tcr.2024.101003 -
International Journal of Molecular... Mar 2024Fracture healing is a complex series of events that requires a local inflammatory reaction to initiate the reparative process. This inflammatory reaction is important...
Fracture healing is a complex series of events that requires a local inflammatory reaction to initiate the reparative process. This inflammatory reaction is important for stimulating the migration and proliferation of mesenchymal progenitor cells from the periosteum and surrounding tissues to form the cartilaginous and bony calluses. The proinflammatory cytokine interleukin (IL)-17 family has gained attention for its potential regenerative effects; however, the requirement of IL-17 signaling within mesenchymal progenitor cells for normal secondary fracture healing remains unknown. The conditional knockout of IL-17 receptor a () in mesenchymal progenitor cells was achieved by crossing mice with mice to generate ; mice. At 3 months of age, mice underwent experimental unilateral mid-diaphyseal femoral fractures and healing was assessed by micro-computed tomography (µCT) and histomorphometric analyses. The effects of IL-17RA signaling on the osteogenic differentiation of fracture-activated periosteal cells was investigated in vitro. Examination of the intact skeleton revealed that the conditional knockout of decreased the femoral cortical porosity but did not affect any femoral trabecular microarchitectural indices. After unilateral femoral fractures, conditional knockout impacted the cartilage and bone composition of the fracture callus that was most evident early in the healing process (day 7 and 14 post-fracture). Furthermore, the in vitro treatment of fracture-activated periosteal cells with IL-17A inhibited osteogenesis. This study suggests that IL-17RA signaling within + mesenchymal progenitor cells can influence the early stages of endochondral ossification during fracture healing.
Topics: Animals; Mice; Femoral Fractures; Fracture Healing; Inflammation; Mesenchymal Stem Cells; Osteogenesis; X-Ray Microtomography; Receptors, Interleukin-17; Homeodomain Proteins
PubMed: 38612562
DOI: 10.3390/ijms25073751 -
Cancer Imaging : the Official... Apr 2024The preoperative identification of tumor grade in chondrosarcoma (CS) is crucial for devising effective treatment strategies and predicting outcomes. The study aims to...
OBJECTIVE
The preoperative identification of tumor grade in chondrosarcoma (CS) is crucial for devising effective treatment strategies and predicting outcomes. The study aims to build and validate a CT-based radiomics nomogram (RN) for the preoperative identification of tumor grade in CS, and to evaluate the correlation between the RN-predicted tumor grade and postoperative outcome.
METHODS
A total of 196 patients (139 in the training cohort and 57 in the external validation cohort) were derived from three different centers. A clinical model, radiomics signature (RS) and RN (which combines significant clinical factors and RS) were developed and validated to assess their ability to distinguish low-grade from high-grade CS with area under the curve (AUC). Additionally, Kaplan-Meier survival analysis was applied to examine the association between RN-predicted tumor grade and recurrence-free survival (RFS) of CS. The predictive accuracy of the RN was evaluated using Harrell's concordance index (C-index), hazard ratio (HR) and AUC.
RESULTS
Size, endosteal scalloping and active periostitis were selected to build the clinical model. Three radiomics features, based on CT images, were selected to construct the RS. Both the RN (AUC, 0.842) and RS (AUC, 0.835) were superior to the clinical model (AUC, 0.776) in the validation set (P = 0.003, 0.040, respectively). A correlation between Nomogram score (Nomo-score, derived from RN) and RFS was observed through Kaplan-Meier survival analysis in the training and test cohorts (log-rank P < 0.050). Patients with high Nomo-score tumors were 2.669 times more likely to suffer recurrence than those with low Nomo-score tumors (HR, 2.669, P < 0.001).
CONCLUSIONS
The CT-based RN performed well in predicting both the histologic grade and outcome of CS.
Topics: Humans; Nomograms; Radiomics; Chondrosarcoma; Bone Neoplasms; Tomography, X-Ray Computed; Retrospective Studies
PubMed: 38605380
DOI: 10.1186/s40644-024-00695-7