bluuebunny/crossref_metadata_2025 huggingface dataset:
Thyroid hormone T3 augments the cytotoxicity of sorafenib in Huh7 hepatocellular carcinoma cells by suppressing AKT expression
Authors: Uyulgan Sude , Köse Sıla Naz , Kıpçak Arda , Başkan Yağmur , Dağlar Gökçe , Karagonlar Zeynep Fırtına , Yandım Cihangir
Published: June 2024

Background and Objectives:

Hepatocellular carcinoma (HCC) is a primary cancer that poorly responds to treatment. Molecular cancer studies led to the development of kinase inhibitors, among which sorafenib stands out as a multi-kinase inhibitor approved by FDA for first line use in HCC patients. However, the efficiency of sorafenib was shown to be counteracted by numerous subcellular pathways involving the effector kinase AKT, causing resistance and limiting its survival benefit. On the way of breaking such resistance mechanisms and increase the efficiency of sorafenib, deeper understanding of hepatocellular physiology is essential. Thyroid hormones were shown to be metabolized in liver and inevitably affect the molecular behaviour of hepatocytes. Interestingly, thyroid hormone T3 was also demonstrated to be potentially influential in liver regeneration and treatment with this hormone reportedly led to a decrease in HCC tumor growths. In this study, we aimed to uncover the impact of T3 hormone on the cytotoxic response to sorafenib in HCC in vitro.

Materials and Methods:

We pre-treated the HCC cell line Huh-7 with T3 prior to sorafenib exposure both in 2D and 3D culture. We checked cell viability with MTT assay in 2D culture and measured the sizes of 3D spheroids with bright-field microscopy followed by a surface analysis with ImageJ. We also performed scratch assay to measure cell migration as well as western blot and qPCR to uncover affected pathways.

Results:

We observed an additive effect to sorafenib’s cytotoxicity both in 2D and 3D culture. Cell migration assay also confirmed our finding and pointed out a benefit of T3 hormone in HCC cell migration. Western blot experiments showed that T3 exerts its additive effect by suppressing AKT expression upon sorafenib treatment both at protein and gene expression levels.

Conclusion:

Our results open a promising new avenue in increasing sorafenib’s cytotoxicity where thyroid hormone T3 is utilized to modulate AKT expression to combat resistance, and warrant further studies in the field.
Quality of life in patients treated with breast cancer surgery and adjuvant systemic therapy and/or adjuvant radiotherapy in Uruguay
Authors: Camejo Natalia , Amarillo Dahiana , Castillo Cecilia , Guerrina María , Savio Florencia , Carrasco Mariana , Strazzarino Noelia , Hernandez Ana Laura , Herrera Guadalupe , Krygier Gabriel
Published: June 2024

Introduction:

Breast cancer (BC) and its treatment can impair patient quality of life (QoL), and those undergoing more aggressive treatments may be more severely impacted. Objective: Assess the level of perception of the QoL of patients treated for BC at the Hospital de Clínicas and the Departmental Hospital of Soriano.

Materials and Methods:

A questionnaire for cancer patients (EORTC, QLQ-C30) and one specific for BC (EORTC QLQ-BR23) were used.

Results:

A total of 158 patients who had completed chemotherapy treatment at least one year prior to the evaluation were enrolled. The average age was 61 years old.

QLQ-C30 Questionnaire:

The global QoL score (GQOL) was high: 70.9. Patients undergoing breast-conservation surgery (BCS) had better scores in physical and emotional functioning (p < 0.005) and presented less frequently with: pain, constipation, and financial difficulties (p < 0.005). Those undergoing sentinel lymph node biopsy (SLNB) had higher scores for GQOL and for physical, role, and social functioning scales (p < 0.001) and had less fatigue, pain, insomnia, and financial difficulties (p < 0.005).

Questionnaire QLQ-BR23:

Sexual functioning and sexual enjoyment scales were relatively low. Patients undergoing BCS had better scores on the functional scales: body image and future outlook; and fewer breast symptoms (p < 0.005). Those undergoing SLNB also had better scores on the functional scales for body image and future outlook future and presented less frequently with symptoms (p < 0.005).

Conclusion:

Uruguayan BC patients experience high values on the GQOL scale; those undergoing BCS and SLNB had better scores on most functional and problem/symptom scales. Patients undergoing BCS had better scores in physical and emotional functioning and presented less frequently with pain, constipation, and financial difficulties. With respect to the type of axillary surgery received, patients who underwent SLNB had higher scores on the GQOL scale and on the physical, role, and social functional scales. The implementation of intervention strategies aimed at improving the quality of life, and the physical and emotional care of patients is recommended.
Transcutaneous electrical acupoint stimulation for alleviating pain in patients with advanced pancreatic cancer
Authors: Tian Wei , Zhang Yun , Yu Bingjie , Jin Haiyan , Wang Wen , Yuan Ting , Yu Shulin , Lu Haiyan
Published: June 2024

Introduction:

Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related deaths globally, with a five-year survival rate of only 5%.

Objectives:

Pancreatic ductal adenocarcinoma is often fatal because of the lack of specific early symptoms and effective early screening tools. Therefore, 80%–85% of patients are usually diagnosed in the advanced stages. This study aimed to investigate the analgesic effect of transcutaneous electrical acupoint stimulation in patients with advanced pancreatic cancer.

Methods:

Eighty patients with advanced pancreatic cancer were recruited from the Integrative Medicine Department of our hospital between June 2017 and October 2018 and randomly divided into the experimental group (n = 40) and the control group (n = 40). The experimental group received transcutaneous electrical acupoint stimulation combined with analgesic medication for 3 consecutive days, while the control group received only analgesic medication. The pain scores of the two groups before and after intervention were compared.

Results:

The mean pain severity score was significantly lower in the experimental group than in the control group on day 1 (P < 0.001), day 2 (P < 0.001), day 3 (P = 0.005), and day 4 (P = 0.043).

Conclusion:

Transcutaneous electrical acupoint stimulation therapy effectively alleviates the pain of patients with advanced pancreatic cancer with a high degree of safety and minimal adverse effects, and is worthy of clinical application.
Quantum dots in noninvasive imaging of oral squamous cell carcinomas: A scoping literature review
Authors: Shetty Bhagyashree , Chauhan Rashmi S. , Tirupathi Sunnypriyatham , Krishnapriya Nene , Patil Lalit , Rathi Nilesh
Published: June 2024

The current scoping review’s objective was to outline existing applications, recent breakthroughs, and quantum dots’ applicability in imaging of oral squamous cell cancer. Quantum dots are nanometric semiconductor crystals with customizable optical characteristics and intense, stable fluorescence suited for bioimaging and labeling. We used the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations for conducting our systematic search. An analysis of the properties and applications of quantum dots in noninvasive detection of oral squamous cell cancer is presented in this study, which comprehensively explores the available evidence. Following searches in the databases PubMed, Ovid SP, and Cochrane using the search terms quantum dots AND oral squamous cell cancer, 55 published publications were chosen for this review. The review identified a total of eight papers that met the criteria. In noninvasive detection of oral squamous cell carcinoma, quantum dots have the potential to offer an array of therapeutic and diagnostic applications. Furthermore, quantum dots emit near-infrared and visible light, which is advantageous in biological imaging since it reduces light dispersion and absorption of tissue. The future may see quantum dots become a popular noninvasive imaging technique for oral squamous cell cancer. The number of studies accessible is quite limited, and further research is required.
INSM1 expression in neuroendocrine tumors in a tertiary care hospital
Authors: Chandrasekaran Kundhavai , Sundaram Sandhya , Balasubramanian Subalakshmi
Published: June 2024

Aim:

Neuroendocrine tumors are heterogenous group of neoplasms that includes benign and malignant tumors that originate from neuroendocrine or nonneuroendocrine organs. Insulinoma-associated protein 1 (INSM1) is a zinc finger transcription factor originally isolated from subtraction library of human insulinoma. The main aim was to study the INSM1 expression in a spectrum of neuroendocrine tumors and a limited spectrum of nonneuroendocrine tumors.

Materials and Methods:

A total of 100 cases of which 57 neuroendocrine neoplasms and 43 nonneuroendocrine neoplasms were included in the study. Immunohistochemistry (IHC) was done and expression patterns of INSM1 were analyzed. Pituitary adenoma, medullary carcinoma of thyroid, pheochromocytoma lung, gastrointestinal, and pancreatic neuroendocrine tumors were the neuroendocrine tumors that were included in the study. Papillary carcinoma of thyroid, gastrointestinal adenocarcinoma, lung adenocarcinoma, and squamous cell carcinoma were the nonneuroendocrine tumors that were included in the study. Depending upon the tissue availability, comparison of INSM1 with synaptophysin and chromogranin was also done in few neuroendocrine tumors.

Results:

All the 57 neuroendocrine tumors showed positive expression for INSM1 and all the nonneuroendocrine tumors were negative for INSM1. This study is statistically significant.

Conclusion:

Our study suggests that INSM1 is a diagnostic marker for neuroendocrine tumors with high degree of sensitivity and specificity. The study is significant and suggests that INSM1– IHC shows nuclear positivity in a spectrum of neuroendocrine tumors. Being a nuclear marker, interpretation is easy and more reliable than the cytoplasmic markers. INSM1 has a stronger positivity than synaptophysin and chromogranin in the present study especially for small cell carcinoma lung. Hence, INSM1 may be included in the routine panel for neuroendocrine tumors along with synaptophysin and chromogranin.
Case series of urachal adenocarcinoma: Imaging features
Authors: Sah Anjali , Triveni GS , Chandrashekhara SH
Published: June 2024

Urachal adenocarcinoma is an unusual and aggressive form of bladder cancer that arises from urachus, a midline fibrous remnant of allantois. Experience with diagnosing them is limited and differentiating urachal adenocarcinoma from other urachal pathologies like infected urachal cysts may be difficult at times. Differentials of urachal anomalies can be narrowed down by proper assessment of patient demographics, clinical details, lesion morphology, and imaging findings. With this case series of five patients of urachal adenocarcinoma, we have tried describing their clinical manifestation and imaging appearances.
A prospective study on the effect of tumor shrinkage on exit fluence gamma pass rate in high precision radiotherapy and influence of phantom setup error in patient-specific quality assurance
Authors: Tiwari Arnav , Das Saikat , Pandey Vindhyavasini P. , Kharade Vipin , Gupta Manish , Pasricha Rajesh
Published: June 2024

Purpose:

Objective parameters for decision on adaptive radiotherapy depend on patient, tumor and treatment related factors. Present study reports geometric uncertainties occurring during high precision radiotherapy, beam fluence analysis and serial exit dose measurement as a patient-specific tool for adaptive radiotherapy.

Materials and Methods:

Serial exit dose fluence of 24 patients (at baseline and mid-treatment) undergoing IMRT/VMAT treatment were measured. Baseline and midtreatment exit dose evaluation was done using gafchromic films in predefined region of interest. Difference of volume of GTV at baseline (from simulation CT scan) and midtreatment CBCT scan was calculated (ΔGTV).

Results:

Population based systematic errors (mm) were 4.15, 2.26, 0.88 and random errors (mm) were 2.56, 3.69, and 2.03 in mediolateral (ML), craniocaudal (CC) and anteroposterior (AP) directions respectively. Gamma pass rate reduced with incremental shift. For a 5 mm shift, maximum deviation was found in anteroposterior axis (22.16 ± 7.50) and lowest in mediolateral axis (12.85 ± 4.95). On serial measurement of exit dose fluence, tumor shrinkage significantly influenced gamma pass rate. The mean gamma pass rate was significantly different between groups with 50% shrinkage of tumor volume (86.36 vs 96.24, P = 0.008, on multivariate analysis P = 0.026).

Conclusion:

Rapid fall of gamma pass rate was observed for set up error of ≥3 mm. Serial measurement of exit dose fluence by radiochromic film is a feasible method of exit dose comparison in IMRT/VMAT, where EPID dosimetry is not available with linear accelerator configuration. Our study suggests that there is a significant difference between gamma pass rates of baseline and mid treatment exit dose fluence with greater than 50% tumor shrinkage.
Predictors of residual disease after breast conservation surgery for ductal carcinoma in situ: A retrospective study
Authors: Patterson Ryan , Guest Mitchell , Shenouda Mariam , Pareek Vibhay , Galloway Katie , Bucher Oliver , Hebbard Pamela , Nashed Maged
Published: June 2024

Background:

Breast-conserving therapy is the standard of care for ductal carcinoma in situ (DCIS). Debate on what constitutes a satisfactory margin persists. This study aimed to identify predictors of residual disease at re-excision.

Methods:

This is a population-based retrospective cohort study of women with DCIS who underwent a lumpectomy between 2007 and 2017 in Manitoba, with close (≤2 mm) or positive margins that led to re-excision.

Results:

The DCIS re-excision rate was 29.3% for 1001 patients. 63.2% of patients were found to have residual disease on re-excision. On univariable analysis, the size, margin status, number of positive margins, type of second surgery, and Van Nuys Prognostic Index score were associated with residual disease on re-excision. The size of DCIS and the number of positive margins remained statistically significant on multivariable analysis.

Conclusions:

Re-excision should be rationalized by considering the predictors of residual disease in conjunction with other factors.
Leiomyosarcoma of the bone: Unveiling the mystery of a spindly ossein
Authors: Shetty K Jayaprakash , Kishan Prasad HL , Kotian Shravya , Joshi Divya , Mathias Lawrence , Bhat Shubha
Published: June 2024

Leiomyosarcoma (LMS) represents one of the most common soft tissue sarcomas, involving various anatomical sites like the retroperitoneum, genitourinary tract, and extremities. LMS of the bone is extremely rare, with a 0.7% incidence of all primary malignant bone tumors. They are histologically identical to the leiomyosarcomas of other sites but pose a diagnostic dilemma due to their rarity and varied presentation when it manifests as a bony lesion.
Imatinib in c-KIT-mutated metastatic solid tumors: A multicenter trial of Korean Cancer Study Group (UN18-05 Trial)
Authors: Kim Hye Ryeon , Lee Su Jin , Ahn Mi Sun , Kim Jeong Eun , Kang Myoung Joo , Hong Jung Yong , Lee Jeeyun , Kim Seung Tae
Published: June 2024

Introduction:

We conducted an open-label, single-arm, multi-center phase II trial to evaluate the efficacy and safety of imatinib chemotherapy-refractory or metastatic solid tumor patients with c-KIT mutations and/or amplification.

Methods:

c-KIT mutations and amplification were detected using NGS. Imatinib (400 mg daily) was administered continuously in 28-day cycles until disease progression, unacceptable adverse events, or death by any cause. The primary endpoint was the objective response rate (ORR).

Result:

In total, 18 patients were enrolled on this trial. The most common tumor type was melanoma (n = 15, 83.3%), followed by ovarian cancer, breast cancer, and metastasis of unknown origin (MUO) (each n = 1, 5.5%). The total number of evaluable patients was 17, of which one patient had a complete response, six patients had partial response, and two patients had stable disease. The overall response rate (ORR) of 41.2% (95% CI 17.80–64.60) and a disease control rate of 52.9% (95% CI 29.17–76.63). The median progression-free survival was 2.2 months (95% CI 1.29–3.20), and median overall survival was 9.1 months (95% CI 2.10–16.11). The most common adverse events were edema (31.3%), anorexia (25.0%), nausea (18.8%), and skin rash (18.8%).

Conclusion:

Imatinib demonstrated modest anti-tumor activity and a manageable safety profile in chemotherapy-refractory solid tumors with c-KIT mutation, especially in melanoma patients.
Colorimetric Evaluation of Various Orthodontic Thermoformed Retainers Exposed to Different Staining Agents and Cleaning Techniques
Authors: Singh Swati , Jain Ravindra Kumar
Published: June 2024

Aims:

The aim of this in vitro study was to evaluate the color changes in the retainers by different manufacturers (Essix ACE, Forestadent, Leone, and Bioart) after exposure to various beverage solutions (coke, tea, coffee, and artificial saliva) and also to assess the stain removal potential of different cleansing agents [listerine (L) and retainer brite (RB)].

Materials and Methods:

A total of 320 specimens (80 samples in each group) of thermoformed retainers from four different manufacturers were tested. All retainers were thermoformed and were immersed in different beverages (black tea, coffee, and cola) and artificial saliva as a control group for 7 and 14 days. These were then cleaned by either L or RB crystals. The color changes (ΔE) in several retainers were assessed following a 7-day exposure (T1–T0), a 14-day exposure (T2–T0), and following cleaning (T3–T1 and T3–T2). The CIELAB color space approach was utilized to obtain the ΔE measurements. To statistically evaluate the data, t test, analysis of variance, Tukey’s range test, and Levene’s test were employed.

Results:

On intragroup comparison, all groups were stained by tea with significant differences at 7 and 14 days (P < 0.05). Significant differences in color change after cleaning by L at the 7-day interval (P < 0.05) were noted in group A for immersion in cola. No significant difference was noted for groups B and C (P > 0.05). Significant differences in color change after cleaning with RB for tea stains in group D (P < 0.05) were noted. Significant intergroup differences in staining were noted for tea at 7- and 14-day intervals (P < 0.05) with maximum staining in group D. For coffee, significant intergroup differences were noted with maximum staining in group A (P < 0.05) at both 7- and 14-day intervals. Significant intergroup differences in cleaning were noted at the 12- h interval in group A for tea stains by RB (P < 0.05) and cola stains by L (P < 0.05).

Conclusions:

Tea exhibited the greatest staining potential among all staining agents at 7-and 14-day intervals for Forestadent, Leone, and Bioart retainers, while coffee stained Essix ACE retainers the most. Among the four different retainer brands, Bioart exhibited the least staining with the various staining agents at 7- and 14-day intervals. RB eliminated tea stains better, whereas cola and coffee stains were better removed by L.
Assessment of Enamel Surface Using Scanning Electron Microscope After Debonding Conventional and Self-Ligating Metal and Ceramic Brackets: An In Vitro Study
Authors: Lishna Karalikkattil T , Shaloob Muhamed , Antony Vincy , Roshan Gazanafer , Parayaruthottam Prathapan , Mohammed Nayaz VP , Raheesh Muhammed
Published: June 2024

Aims:

Minimal enamel loss during bonding and debonding operations is ideal for preserving the enamel surface in fixed orthodontic treatment. This study aimed to assess the enamel surface after debonding conventional and self-ligating metal and ceramic brackets and compare their enamel damage index (EDI) and adhesive remnant index (ARI) using scanning electron microscopy (SEM).

Materials and Methods:

Thirty-two maxillary first premolar teeth were divided into four equal groups of eight teeth each. According to the type of brackets used, the teeth were set on acrylic blocks that were color-coded: Conventional metal brackets (ORMCO MINI 2000), Self-ligating metal brackets (ORMCO DAMON Q), conventional ceramic brackets (ORMCO SYMETRI CLEAR), and self-ligating Ceramic brackets (ORMCO DAMON CLEAR). After debonding was done using a straight debonding plier, the tooth surfaces were examined by SEM. The ARI and EDI were then evaluated. The Kruskal–Wallis test was used in inferential statistics to determine differences between the groups. The association between the ARI and the EDI was determined using the Pearson correlation test.

Results:

The ARI revealed lower values for teeth bonded with traditional ceramic brackets, along with higher scores in the EDI. This suggests that the enamel-resin interface was the primary site of bond failure, potentially leading to iatrogenic tooth surface damage from ceramic bracket debonding. Conversely, self-ligating stainless-steel brackets had the lowest EDI scores and higher ARI values, suggesting that the resin-bracket interface was the primary site of bond failure. Additionally, this group showed minimal to no enamel damage, with only a few enamel cracks observed.

Conclusion:

Self-ligating metal brackets showed the highest ARI scores and lowest EDI scores, whereas conventional ceramic brackets presented with lowest ARI scores and highest EDI scores. The enamel surfaces attached with ceramic brackets showed greater enamel cracks upon SEM analysis.
Triple Endobutton with Coracoacromial Ligament Transfer: A Modified Technique for Fixation of Acromioclavicular Joint Dislocation
Authors: Kesari Vikas , Prakash Jatin , Garg Jyoti , Jalan Divesh , Maggo Karan , Bhatia Naval
Published: June 2024

Introduction:

The study explores a novel technique for the fixation of acromioclavicular joint (ACJ) dislocation utilizing triple Endobutton and coracoacromial ligament (CAL) transfer. ACJ dislocations are common injuries that can lead to significant functional impairment and pain. Current treatment options often fall short of providing long-term stability and functional outcomes. Therefore, the development of new techniques is imperative to enhance patient outcomes.

Materials and Methods:

A prospective analysis was conducted on a cohort of patients with ACJ dislocation who were treated using the triple Endobutton and CAL transfer techniques. In this procedure, the lateral end of the clavicle, the coracoid, and the CAL were exposed. Two tunnels were drilled in the lateral clavicle and one in the coracoid. An Endobutton loaded with No. 2 FiberWire was passed under the coracoid and the medial clavicle tunnel in a retrograde manner. ACJ was then reduced and the No. 2 FiberWire was tied over the Endobutton on the clavicle. CAL was then passed through the lateral clavicle tunnel and tied over the Endobutton. Patients were evaluated based on clinical, radiological, and patient-reported outcomes.

Results:

In this study, 38 patients underwent ACJ dislocation repair using the triple Endobutton and CAL transfer technique. The patients’ ages ranged from 22 to 48 years, with a mean age of 39.4 years. The majority of patients was males (24) and had right-sided injuries (21). Dislocations were predominantly grade V (16 cases). Postoperative outcomes showed significant improvements in pain levels, functional scores, and joint alignment. The average Visual Analog Scale score decreased from 6.24 to 0.62, Constant Shoulder score improved from 29.5 to 88.3, and disability of the arm, shoulder, and hand scores decreased from 21.79 to 1.33. Radiographic evaluation demonstrated satisfactory joint alignment with no significant differences between right and left CC distances. No loss of reduction or major complications were observed, although two cases of superficial skin infections were treated successfully.

Conclusion:

The triple Endobutton and CAL transfer technique represents a satisfactory technique in the fixation of ACJ dislocation.
Arthroscopic Rotator Cuff Restoration Using Sironix Suture Anchor: A Retrospective Observational Study
Authors: Shah Krunal , Manwani Ruchita , Moharana Ashok Kumar , Angrish Sachin , Deepak T. S.
Published: June 2024

Purpose:

The most effective approach to treat individuals with rotator cuff tears (RCTs) remains uncertain, but operative treatment, especially arthroscopic surgery with various suture anchors, is becoming more popular. The purpose of this study was to assess the functional outcomes in patients who underwent arthroscopic RCTs restoration using Sironix suture anchors.

Materials and Methods:

Eighty patients (36 males and 44 females) who had arthroscopic rotator cuff restoration using Sironix suture anchors were included. Postoperatively, patients were followed up and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons Standardization Shoulder Assessment (ASES), level of activity using the Simple Shoulder Test (SST) questionnaire, Quality of life using the Shoulder Pain and Disability Index (SPADI) scale, and Single Assessment Numerical Evaluation (SANE) score on a scale of 0–100. Adverse events were recorded post-RCTs restoration.

Results:

The functional outcomes were presented as the mean (standard deviation [SD]) values of total ASES, SPADI, and SST scores, which were observed to be 92.6 (05.28), 01.6 (02.46), and 90.3 (14.22), respectively. The SANE mean (SD) values of the operated shoulder and the opposite shoulder were 91.8 (10.22) and 97.3 (5.68), respectively, with aP= 0.0001. No serious adverse events were reported and none of the subjects discontinued the study.

Conclusions:

The current study demonstrated that the functional outcomes were quite satisfactory, with good results. Therefore, Sironix shoulder implants (CEPTRE®Knotted UHMWPE Suture PEEK Anchor and CEPTRE®Knotted UHMWPE Suture Titanium Anchor) were considered safe and effective in rotator cuff restoration.
Management of Complex Nonunion of Long Bones by Distraction Osteogenesis Using Monorail Fixator
Authors: Khan Azad , Ahmed Parwez , Tomar Vishvendra , Gupta Rahul Kumar , Siddiqui Areeb Ali , Adnan Mohd
Published: June 2024

Background:

Treatment of complex nonunion is tough in the context of previous surgeries, recurrent infection, shortening, bone loss, associated bone deformities, and joint stiffness. Various treatments are available, including the Ilizarov ring fixator which is well established, but poor patient compliance and the bulky fixator push us to conduct another method of bone transport and distraction osteogenesis by monorail fixator. We conducted a study on 26 patients to know the outcome of monorail fixator in the treatment of complex nonunion in terms of rate of union, duration of treatment, and frequency of complications.

Materials and Methods:

The study comprised 26 patients, 22 of whom were male and 4 were female. Majority of cases landing up as complex nonunion were as a result of road traffic accidents. Two-thirds of the patients presenting to us had an infection in the form of discharging sinus or quiescent sinus, while one-third of the patients had aseptic nonunion. Majority of the patients had an external fixator or infected implant at the time of presentation. Corticotomy was done in almost all (96.2%) of the patients.

Results:

Out of 26 patients, treatment was completed in 25 patients, and one patient was lost to follow-up. The mean treatment duration was 11.31 months ranging from 5 months to 21 months. The mean follow-up duration was 12.8 months ranging from 7 months to 22 months. Results were assessed according to the ASAMI scoring system. Bone results were excellent in 19 (76%), good in 3 (12%), fair in 2 (8%), and failure in 1 (4%) cases. Functional results were excellent in 20 (80%), good in 2 (8%), and fair in 2 (8%). One case was declared a failure. Pin tract infection was the most common complication. Other complications encountered were pain during distraction, pin loosening, and joint stiffness. There was no significant angular deviation (>15°) in any case. Neurovascular complications, joint subluxation, or fracture of regenerate was not seen in any of the cases. Delayed maturation of the regenerate was dealt with by slowing or stopping the distraction for some days.

Conclusion:

It is concluded that the limb reconstruction system (LRS) (monorail fixator) is less bulky and relatively simple to apply, patient compliance is very good, operating time is considerably less, and no preoperative frame assembly is required. Good patient satisfaction, less pain during bone transport, less fluoroscopy exposure, and easy care management of concomitant soft-tissue injury are added advantages of LRS (monorail fixator).
Erector Spinae Plane Block for Control of Postoperative Pain in Patients Undergoing Thoracolumbar Spinal Fracture Fixation
Authors: Bhattacharya Sushruta , Banerjee Priti , Hazra Sunit , Mukhopadhyay Kiran Kumar
Published: June 2024

Introduction:

Post operative pain control in thoracolumbar spinal fixation following fracture is important for early rehabilitation. Erector Spinae Plane block (ESB) is an effective method.

Study Design:

A prospective comparative longitudinal observational study.

Objective:

The objective is to study the efficacy of erector spinae plane block (ESB) with general anesthesia (GA) in postoperative analgesia in comparison to GA only in thoracolumbar spinal fracture surgery.

Materials and Methods:

A total of 40 patients enrolled for the study were randomly allocated into two groups, 20 patients received GA without ESB and 20 patients with GA and ESB. Numerical rating scale (NRS) pain score was noted in postoperative period at 1, 2, 4, 6, 9, and 24 hours, respectively.

Results:

There was a statistically significant difference in NRS score for 1, 2, 4, 6, and 9 h and the ESB group had better pain control but at 24 h, there was no statistically significant difference was noted.

Conclusion:

Postoperative pain control directly affects the recovery of a patient in any surgical condition. Thoracolumbar spine fracture fixation is a major surgery and postoperative pain control plays a major role during the early recovery period. ESB has been shown a very effective, cost-effective method of pain control in thoracolumbar spine surgery for fractures.
Reverse Sural Artery Flap – A Versatile Option in Distal Lower-limb Reconstruction
Authors: Prakash Om , Ali Sheikh Sarfraz , Khurram Mohammed Fahud , Yaseen Mohd.
Published: June 2024

Background:

The biggest barriers to the reconstruction of soft-tissue defect in the distal part of the lower limb are the paucity of local vascularized soft tissue and the mechanical demands of the region. Advancements in microsurgery techniques and low complication rates have made free tissue transfer the method of choice. However, the option of microsurgery may not be available at all centers. The reverse sural artery flap (RSAF) provides a reliable alternative for covering soft-tissue defects of the distal parts of the lower extremity.

Objective:

The aim of this study was to assess the versatility and efficacy of RSAF for providing coverage for soft-tissue defects over the distal parts of the lower limb.

Materials and Methods:

A retrospective, observational, and descriptive study was performed through a data survey of medical records of patients treated between August 2020 and January 2023.

Results:

A total of 25 patients underwent surgery, 21 males and 4 females. The age range of patients was from 18 to 55 years. Tissue defects following trauma constituted majority of the cases. Four patients had partial flap necrosis. No case of total necrosis of flap was recorded. The average duration of hospital stay was 15.6 days.

Conclusion:

The reverse-flow fasciocutaneous sural flap proved to be a feasible, easily reproducible, and reliable option for reconstruction of distal lower-limb defects.
Original Report: “All inside vs Antero medial portal anterior cruciate ligament reconstruction technique: which is better?”
Authors: Gupta Lalit Mohan , Vivek Vivek , Ghai Amresh , Sood Munish , Singh Shalendra , Dhawan Vikas
Published: June 2024

Objective:

Anterior cruciate ligament (ACL) tears are common injuries and have long-term effects on sportspersons and high-demand professionals like military personnel. The goal of ACL reconstruction surgery is to get back the individual to the preinjury status which may not always be possible. The study aimed to assess outcomes using two techniques of ACL reconstruction.

Materials and Methods:

Fifty patients with an isolated ACL injury and meeting the inclusion were operated on and evaluated at our center using all-inside and anteromedial ACL reconstruction techniques. Twenty-five patients were operated using each technique. The groups were compared in terms of operative issues and postoperative complications, in addition to functional outcome scores and Tegner’s return to injury level.

Results:

The average age of patients was more than 30 years. All were male patients. Sports injuries were the most common mode of injury in both groups constituting more than 60% of all the injuries. The median Tegner, mean Lysholm score, and mean 2000 International Knee Documentation Committee subjective knee score were comparable preoperatively, and the scores improved in both the groups at the final follow-up of 2 years. However, the difference in the score between the two groups was not statistically significant.

Conclusions:

Despite the learning curve, the all-inside ACL reconstruction technique yields outcomes similar to the AM portal technique in terms of functional outcome and return to the preinjury level at mid-term follow-up.
Do Pathologic Fractures in Long Bone Following Bony Malignancy Increase the Risk of Venous Thromboembolism? A Comparative Study
Authors: Rai Sanjay Kumar , Gupta Tej Pratap , Sirohi Bhavya , Rajauria Surbhi , Khandelwal Nitish
Published: June 2024

Background:

Venous thrombosis is a dreaded complication of long bone fractures. The occurrence of deep vein thrombosis (DVT) may be high in specific cases such as bone tumors with pathological fractures. In this regard, more work is required to establish its correlation. Scanty data are available that shows whether pathological fractures increase the risk of DVT by comparing fracture fixation and replacement surgeries as a treatment. The anticoagulation protocols in published literature might not be suitable for this specific group.

Materials and Methods:

In a retrospective study on patients who underwent surgeries for pathological fracture fixation between September 2010 and October 2020. Their data were collected and analyzed. DVT is diagnosed by clinical sign, D-dimer test, and using color Doppler. The study population (n = 68) was compared and paired with a control group (n = 140) with similar baseline characteristics.

Results:

There were 12 patients (17.64%) in the study group and 8 (5.71%) patients in the control group that developed DVT after performing risk ratio and Student’s t-test and calculating odds ratio (P < 0.031). There was a statistically significant correlation found between the development of DVT with the type of implant used, the presence of neoplastic lesions, and the presence of metastases.

Conclusion:

Patients with a pathological long bone fracture who underwent surgical management are at greater risk for DVT or death due to pulmonary embolism under the current recommended thromboprophylaxis protocol. This risk of developing DVT is increased much fold in the presence of metastasis, chemotherapy, radiotherapy, fracture fixation, and arthroplasty.
An Unusual Case of Primary Aneurysmal Bone Cyst of the Patella with a Review of Literature
Authors: Mugdum Girish , Kaul Rajiv , Mishra Anil Kumar
Published: June 2024

Tumors of the patella are uncommon. A 28-year-old male, who presented with intermittent knee pain of 9 months duration, with swelling and tenderness over the patella underwent a clinico-radiological evaluation which revealed fluid-fluid levels, suggestive of an aneurysmal bone cyst (ABC). Conventional treatment of ABCs usually consists of curettage and autologous bone grafting. However, in this case, a total patellectomy resulted in full functional restoration and resumption of activities, thereby ascertaining this method as a successful treatment option for primary ABC of the patella.
Intramedullary Osteosclerosis of the Tibia Diaphysis
Authors: Dharmshaktu Ganesh Singh , Kamat Ajay , Dharmshaktu Ishwar Singh
Published: June 2024

Intramedullary osteosclerosis (IMOS) is an uncommon clinical entity that represents isolated sclerosis within a segment of the medullary cavity of a long bone. Obliteration of the medullary cavity, in the absence of associated features of common causes such as infection, neoplasm, or injury should arise suspicion of this rare differential diagnosis. Localized pain and swelling, but without any periosteal changes, adjacent soft-tissue edema or bony abnormality, may be suggestive of IMOS. Careful radiological assessment and the use of advanced imaging modalities are important to reach to the appropriate diagnosis. We, hereby, describe a case with pain in the left mid-leg region and showing evidence of a segment of sclerosis within the medullary cavity on both the radiograph and magnetic resonance imaging. Open biopsy was done following the creation of a cortical window and was followed by multiple drilling of the adjacent area of the bone. The pain was dramatically relieved postsurgery and the histopathology reports were suggestive of IMOS. There was neither a recurrence of the symptoms nor any complications reported in the follow-up of 15 months.
Vitreous Hemorrhage in Nigerians
Authors: Akanbi Toyin , Okonkwo Ogugua Ndubuisi , Ovienria Wilson , Adenuga Olukorede O. , Nkanga Dennis , Ibanga Affiong A. , Udoh Martha-Mary Ekong , Agweye Chineze Thelma , Oyekunle Idris
Published: June 2024

Aim:

This study aims to determine the prevalence, causes, and systemic associations of vitreous hemorrhage (VH) among Nigerians.

Materials and Methods:

A multicenter cross-sectional study was conducted from January to December 2018. Data were obtained from patients diagnosed with retinal diseases at the general outpatient and retinal clinics of four eye departments in Nigeria. Patient histories were collected. All patients underwent visual acuity and comprehensive ocular examinations. VH was diagnosed clinically. Patients diagnosed with dense VH underwent ultrasonography. Data analysis was performed using IBM SPSS Statistics Version 22. Frequencies, means, and standard deviations were calculated. Significance tests were conducted using Pearson’s chi-square test. A significance level of P < 0.05 was considered statistically significant.

Results:

A total of 8614 patients were examined, among whom 80 eyes of 78 patients were diagnosed with VH. The hospital-based prevalence was 0.9%. The mean age at presentation was 50.44 ± 16.4 years. Males accounted for 62.8%, while females accounted for 37.2%. At presentation, 72.5% of the affected eyes were blind. The cause of VH remained unknown in 37.5% of the cases. The most common causes of VH included proliferative diabetic retinopathy (22.5%), trauma (15.5%), polypoidal choroidal vasculopathy (8.8%), proliferative sickle cell retinopathy (5%), and posterior vitreous detachment (5%). The most prevalent associated systemic disease among patients was hypertension (43.6%).

Conclusion:

The majority of patients presented with blindness. In some cases, the cause of VH could not be identified. This underscores the necessity to improve access to vitrectomy facilities in Nigeria.
Induced neural stem cells regulate microglial activation through Akt-mediated upregulation of CXCR4 and Crry in a mouse model of closed head injury
Authors: Gao Mou , Dong Qin , Zou Dan , Yang Zhijun , Guo Lili , Xu Ruxiang
Published: June 2024

JOURNAL/nrgr/04.03/01300535-202505000-00025/figure1/v/2024-07-28T173839Z/r/image-tiff

Microglial activation that occurs rapidly after closed head injury may play important and complex roles in neuroinflammation-associated neuronal damage and repair. We previously reported that induced neural stem cells can modulate the behavior of activated microglia via CXCL12/CXCR4 signaling, influencing their activation such that they can promote neurological recovery. However, the mechanism of CXCR4 upregulation in induced neural stem cells remains unclear. In this study, we found that nuclear factor-κB activation induced by closed head injury mouse serum in microglia promoted CXCL12 and tumor necrosis factor-α expression but suppressed insulin-like growth factor-1 expression. However, recombinant complement receptor 2-conjugated Crry (CR2-Crry) reduced the effects of closed head injury mouse serum-induced nuclear factor-κB activation in microglia and the levels of activated microglia, CXCL12, and tumor necrosis factor-α. Additionally, we observed that, in response to stimulation (including stimulation by CXCL12 secreted by activated microglia), CXCR4 and Crry levels can be upregulated in induced neural stem cells via the interplay among CXCL12/CXCR4, Crry, and Akt signaling to modulate microglial activation. In agreement with these in vitro experimental results, we found that Akt activation enhanced the immunoregulatory effects of induced neural stem cell grafts on microglial activation, leading to the promotion of neurological recovery via insulin-like growth factor-1 secretion and the neuroprotective effects of induced neural stem cell grafts through CXCR4 and Crry upregulation in the injured cortices of closed head injury mice. Notably, these beneficial effects of Akt activation in induced neural stem cells were positively correlated with the therapeutic effects of induced neural stem cells on neuronal injury, cerebral edema, and neurological disorders post–closed head injury. In conclusion, our findings reveal that Akt activation may enhance the immunoregulatory effects of induced neural stem cells on microglial activation via upregulation of CXCR4 and Crry, thereby promoting induced neural stem cell–mediated improvement of neuronal injury, cerebral edema, and neurological disorders following closed head injury.
Reduced mesencephalic astrocyte–derived neurotrophic factor expression by mutant androgen receptor contributes to neurodegeneration in a model of spinal and bulbar muscular atrophy pathology
Authors: Qin Yiyang , Zhu Wenzhen , Guo Tingting , Zhang Yiran , Xing Tingting , Yin Peng , Li Shihua , Li Xiao-Jiang , Yang Su
Published: June 2024

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Spinal and bulbar muscular atrophy is a neurodegenerative disease caused by extended CAG trinucleotide repeats in the androgen receptor gene, which encodes a ligand-dependent transcription factor. The mutant androgen receptor protein, characterized by polyglutamine expansion, is prone to misfolding and forms aggregates in both the nucleus and cytoplasm in the brain in spinal and bulbar muscular atrophy patients. These aggregates alter protein–protein interactions and compromise transcriptional activity. In this study, we reported that in both cultured N2a cells and mouse brain, mutant androgen receptor with polyglutamine expansion causes reduced expression of mesencephalic astrocyte-derived neurotrophic factor. Overexpression of mesencephalic astrocyte-derived neurotrophic factor ameliorated the neurotoxicity of mutant androgen receptor through the inhibition of mutant androgen receptor aggregation. Conversely, knocking down endogenous mesencephalic astrocyte-derived neurotrophic factor in the mouse brain exacerbated neuronal damage and mutant androgen receptor aggregation. Our findings suggest that inhibition of mesencephalic astrocyte-derived neurotrophic factor expression by mutant androgen receptor is a potential mechanism underlying neurodegeneration in spinal and bulbar muscular atrophy.
Potential role of tanycyte-derived neurogenesis in Alzheimer’s disease
Authors: Qi Guibo , Tang Han , Hu Jianian , Kang Siying , Qin Song
Published: June 2024

Tanycytes, specialized ependymal cells located in the hypothalamus, play a crucial role in the generation of new neurons that contribute to the neural circuits responsible for regulating the systemic energy balance. The precise coordination of the gene networks controlling neurogenesis in naive and mature tanycytes is essential for maintaining homeostasis in adulthood. However, our understanding of the molecular mechanisms and signaling pathways that govern the proliferation and differentiation of tanycytes into neurons remains limited. This article aims to review the recent advancements in research into the mechanisms and functions of tanycyte-derived neurogenesis. Studies employing lineage-tracing techniques have revealed that the neurogenesis specifically originating from tanycytes in the hypothalamus has a compensatory role in neuronal loss and helps maintain energy homeostasis during metabolic diseases. Intriguingly, metabolic disorders are considered early biomarkers of Alzheimer’s disease. Furthermore, the neurogenic potential of tanycytes and the state of newborn neurons derived from tanycytes heavily depend on the maintenance of mild microenvironments, which may be disrupted in Alzheimer’s disease due to the impaired blood–brain barrier function. However, the specific alterations and regulatory mechanisms governing tanycyte-derived neurogenesis in Alzheimer’s disease remain unclear. Accumulating evidence suggests that tanycyte-derived neurogenesis might be impaired in Alzheimer’s disease, exacerbating neurodegeneration. Confirming this hypothesis, however, poses a challenge because of the lack of long-term tracing and nucleus-specific analyses of newborn neurons in the hypothalamus of patients with Alzheimer’s disease. Further research into the molecular mechanisms underlying tanycyte-derived neurogenesis holds promise for identifying small molecules capable of restoring tanycyte proliferation in neurodegenerative diseases. This line of investigation could provide valuable insights into potential therapeutic strategies for Alzheimer’s disease and related conditions.
Single-cell RNA sequencing reveals the heterogeneity and interactions of immune cells and Müller glia during zebrafish retina regeneration
Authors: Xu Hui , Cao Lining , Chen Yuxi , Zhou Cuiping , Xu Jie , Zhang Zhuolin , Li Xiangyu , Liu Lihua , Lu Jianfeng
Published: June 2024

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Inflammation plays a crucial role in the regeneration of fish and avian retinas. However, how inflammation regulates Müller glia (MG) reprogramming remains unclear. Here, we used single-cell RNA sequencing to investigate the cell heterogeneity and interactions of MG and immune cells in the regenerating zebrafish retina. We first showed that two types of quiescent MG (resting MG1 and MG2) reside in the uninjured retina. Following retinal injury, resting MG1 transitioned into an activated state expressing known reprogramming genes, while resting MG2 gave rise to rod progenitors. We further showed that retinal microglia can be categorized into three subtypes (microglia-1, microglia-2, and proliferative) and pseudotime analysis demonstrated dynamic changes in microglial status following retinal injury. Analysis of cell–cell interactions indicated extensive crosstalk between immune cells and MG, with many interactions shared among different immune cell types. Finally, we showed that inflammation activated Jak1–Stat3 signaling in MG, promoting their transition from a resting to an activated state. Our study reveals the cell heterogeneity and crosstalk of immune cells and MG in zebrafish retinal repair, and may provide valuable insights into future mammalian retina regeneration.