Effects and Reversibility of Pre- and Post-natal Iron and Omega-3 Fatty Acid Deficiency, Alone and in Combination, on Bone Development in Rats

Both iron and omega-3 (n-3) polyunsaturated fatty acids may play an important role in bone development. The aim of this study was to investigate the effects of pre- and post-natal iron and n-3 fatty acid deficiency (FAD), alone and in combination, on bone development in rats, and to determine whether effects are reversible when a sufficient diet is provided post-weaning. Using a 2×2-factorial design, 56 female Wistar rats were allocated to one of four diets: (1) control, (2) iron deficient (ID), (3) n-3 FAD or (4) ID and n-3 FAD, and were maintained on the respective diets throughout gestation and lactation. At weaning (post-natal day [PND] 21), offspring (n = 24/group; male:female=1:1) were randomly allocated to either continue with their respective diets or to switch to the control diet until PND 42-45. Bone mineral density (BMD) and bone strength were determined using dual X-ray absorptiometry and three-point bending tests, respectively. Pre- and post-natal ID resulted in significantly lower BMD in the spine and bone strength in the left femur. Both ID and n-3 FAD resulted in lower BMD in the right femur, with an additive reduction in the combined ID and n-3 FAD group vs. controls. While negative effects of pre- and post-natal ID alone were reversed in offspring switched to a control diet post-weaning, lower BMD and bone strength persisted in offspring with combined ID and n-3 FAD during the prenatal and early post-natal period. Effects were not sex-specific. These results indicate that ID during early life may negatively influence bone development, with potential additive effects of n-3 FAD. While the effects of ID alone seem reversible, a combined ID and n-3 FAD may result in irreversible deficits in bone development.

Usual acinar adenocarcinoma and osteoblastic lesion in the distal middle third of the femur, an unusual finding: a case report / Adenocarcinoma acinar usual e lesão osteoblástica no terço médio distal do fêmur, um achado incomum: relato de caso

A patient with prostate cancer may initially be asymptomatic, compromising early diagnosis and treatment. A 42-year-old male patient on a routine examination had a PSA of 4.18 ng / ml. Prostate biopsy revealed usual Gleason 7 stage T2a acinar adenocarcinoma. Magnetic resonance imaging revealed a nodule in the prostate. Bone scintigraphy showed osteoblastic lesion of the left femur, considered a possibility of a secondary lesion to adenocarcinoma, but his biopsy showed tissue without significant histological changes, ruling out malignancy. The patient was submitted to a radical prostatectomy and bilateral lymphadenectomy, evolving without complications. Follow-up tests showed reactive Protein C negative, alkaline phosphatase, lactate dehydrogenase and total testosterone without changes, total PSA 0.011; Free PSA less than 0.01. The total PSA 0.3 indicated a possible recurrence after 3 years. Magnetic resonance imaging showed no suspicious lesions, PET / CT was performed, which showed molecular hyperexpression of specific membrane antigen for the prostate, confirming local recurrence. Therefore, he was submitted to 36 radiotherapy sessions in the prostate bed from July to August. In October, the total PSA was performed, which decreased sharply. The early stage of prostate cancer may show only benign prostate growth, while the advanced stage may reveal bone pain. Bone tissue often develops a metastatic lesion, resulting in a worse prognosis. In this patient, a link between prostate carcinoma and bone lesion was ruled out by biopsy, which demonstrated the absence of spread of the disease.

Bilateral Floating Knee Injuries in an Infant: A Case Report and Literature Review

Background: Floating knee injury is defined as ipsilateral fractures of the femur and tibia. It was mostly seen among young men and is generally caused by high-velocity trauma such as motor vehicle accidents and falling from height. Although isolated fractures of the femur or tibia are relatively common in children, floating knee injuries are rare in adolescents and even less frequent in younger children. Case Report: In this study, we reported a case of bilateral floating knee injuries of a 10-month old girl infant. Radiographic examinations revealed diaphyseal fracture of the left femur and proximal metaphyseal fracture of tibia compatible with floating knee injury type B according to the classification proposed by Letts et al. To the best of our knowledge, there was not any previous report of bilateral infantile floating knee injury in the literature. Conclusion: Pediatric floating knee injuries are relatively uncommon and extremely rare among infants. The preferred method of treatment is a surgical fixation for all fractures of all ages.

Combination approach to diagnosis and treatment of an elderly patient with chronic Ph-negative myeloproliferative neoplasm and concomitant surgical pathology. Clinical observation

Chronic myeloproliferative neoplasms (CMPN), Ph-negative, are of clonal nature, develop on the level of hematopoietic stem cell and are characterized by proliferation of one or more hematopoietic pathways. Currently, the group of Ph-negative CMPN includes essential thrombocythemia, primary myelofibrosis, polycythemia vera, myeloproliferative neoplasm unclassifiable.Identification of mutations in the Jak2 (V617F), CALR, and MPL genes extended understanding of biological features of Ph-negative CMPN and improved differential diagnosis of myeloid neoplasms. Nonetheless, clinical practice still encounters difficulties in clear separation between such disorders as primary myelofibrosis, early-stage and transformation of essential thrombocythemia into myelofibrosis with high thrombocytosis. Thrombocytosis is one of the main risk factors for thromboembolic complications, especially in elderly people.A clinical case of an elderly patient with fracture of the left femur developed in the context of Ph-negative CMPN (myelofibrosis) with high level of thrombocytosis is presented which in combination with enforced long-term immobilization and presence of additional risk created danger of thrombosis and hemorrhage during surgery and in the postoperative period.

REMOVAL OF STUCK FEMUR INTERLOCKING NAIL BY LONGITUDINAL OSTEOTOMY OF FEMUR - A CASE REPORT

Introduction:Gerhard Kuntscher first introduced the technique of intramedullary nailing in 1940s . It is a clover leaf shaped hollow tubular nail for intramedullary fixation of long bones. This nailing system has been a technological breakthrough for femur fixation which can be both anterograde or retrograde. Case Report:A 34 year old Male patient resident of Shahapur brought by relatives to JJ hospital, with chief complaint of pain at left knee since 8 days. Patient had A/H/O RTA after fall from bike in 31/12/2012 with head injury with left shaft femur fracture. Patient was operated at JJH with left femur ILN. History of head injury operated in JJ hospital with no details known to patient. There was also history decreased vision in left eye since trauma. Discussion:Interlocking intramedullary nails are used as gold standard treatment in majority of tibial and femoral diaphyseal fractures. It can be removed in certain circumstances when it causes soft tissue irritation, prominent locking screws, implant failure, infection, nonunion, malunion etc. Conclusion:This study shows that in removal of stuck or bent femur interlocking nails in which all other closed techniques have failed, open longitudinal femoral osteotomy with retrograde hitting of the nail can effectively aid in successful removal of nail.

«THE HEADLESS HORSEMAN». THE SKYTHIAN GRAVE IN THE BARROW NEAR KUSTORIVKA VILLAGE

In 2013 near Kustorivka village of Krasnokutsky district, Kharkov region the Scythian burial mound (5th—4th centuries BC.) was excavated. The inserted burial of a beheaded man has been discovered there. Fragments of horse bones, horse harness, numerous arrowheads, the spearhead and knife were unearthed in the grave. Funeral inventory dates the burial to the 2nd half or the end of 5th — the early 4th century BC. The grave goods allowed us to suggest that the man was a horseman and possessed a bow with arrows, javelin or lance. These assumptions have been confirmed by anthropological studies of the development of muscles relief, injuries and specific skeletal markers. The skeleton showed clear signs of a horseman’ and archer’ osteological complexes. The man died at the age of 20—25. The skull, first and second cervical vertebrae were absent in the undisturbed burial. The upper part of the left intervertebral condyle of the 3rd vertebra was cut off by the hit from left behind and below. These signs are evidence of decapitation. In addition, numerous cut marks made with a sharp blade were found on the anterior and lateral surfaces of the 3rd and 4th cervical vertebrae, as well as on the left femur above the knee. Thus could be the signs of the body cleaning of waste tissue for its transportation or in course of the preparation for the burial. Studies of the horse’s remains showed that it has deceased at the age of 10—12 years. The horse was decapitated as well by the hit directed between first and second cervical vertebra. The head was also cut in half and only one part of it was present in the burial. There were also some bones of the animal’s skeleton, which do not belong to the edible parts of the body. The severed head of the horse was located above the place where the man’s head was supposed to be, thus the horse harness was situated on the level of the human skeleton. Traces of the possible preparation of the human body for burial and the location of the remains of a horse over a lost human head along with other changes in the skeleton indicate a certain funeral rite, direct analogies of which have not yet been found in the North Pontic region.

A Rare Manifestation of a Presumed Non-Osteophilic Brain Neoplasm: Extensive Axial Skeletal Metastases From Glioblastoma With Primitive Neuronal Components

BackgroundGlioblastoma multiforme (GBM) is the most common malignant tumor of the central nervous system. GBM with primitive neuronal component (GBM-PNC) is an aggressive variant identified in 0.5% of GBMs. Extracranial metastasis from GBM-PNC is a rare and challenging situation.MethodsA special case of early-onset GBM with systemic bone metastasis was enrolled. Clinical data, including patient characteristics, disease course, and serial radiological images were retrieved and analyzed. Tumor tissues were obtained by surgical resections and were made into formalin-fixed paraffin-embedded sections. Histopathological examinations and genetic testing were performed for both the primary and metastatic tumor specimens.ResultsA 20-year-old man suffered from GBM with acute intratumoral hemorrhage of the left temporal lobe. He was treated by gross total resection and chemoradiotherapy following the Stupp protocol. Seven months later, he returned with a five-week history of progressive neck pain and unsteady gait. The radiographic examinations identified vertebral collapse at C4 and C6. Similar osteolytic lesions were also observed at the thoracolumbar spine, pelvic, and left femur. Anterior spondylectomy of C4 and C6 was performed. The resected vertebral bodies were infiltrated with greyish, soft, and ill-defined tumor tissue. One month later, he developed mechanical low-back pain and paraplegia caused by thoracolumbar metastases. Another spine surgery was performed, including T10 total en-bloc spondylectomy, T7-9, L2-3, and L5-S1 laminectomy. After the operation, the patient’s neurological function and spinal stability remained stable. However, he finally succumbed to the rapidly increased tumor burden and died 15 months from onset because of cachexia and multiple organ failure. In addition to typical GBM morphology, the histological examinations identified monomorphic small-round cells with positive immunohistochemical staining of synaptophysin and CD99, indicating the coexistence of PNC. The next-generation sequencing detected pathogenic mutations in TP53 and DNMT3A. Based on above findings, a confirmed diagnosis of systemic metastases from GBM-PNC (IDH-wild type, WHO grade IV) was made.ConclusionsThe present case highlights the occurrence and severity of extensive axial skeletal metastases from GBM-PNC. This rare variant of GBM requires aggressive multimodal treatment including surgery and chemoradiotherapy targeting PNC. The pathological screening of PNC is recommended in patients with early-onset GBM and intratumoral hemorrhage. Surgery for spinal metastasis is appropriate in patients with chemoradioresistance and relatively good general status, with the objectives of restoring spinal stability and relieving spinal cord compression.

Pendraig milnerae , a new small-sized coelophysoid theropod from the Late Triassic of Wales

We describe a new small-bodied coelophysoid theropod dinosaur, Pendraig milnerae gen. et sp. nov, from the Late Triassic fissure fill deposits of Pant-y-ffynnon in southern Wales. The species is represented by the holotype, consisting of an articulated pelvic girdle, sacrum and posterior dorsal vertebrae, and an associated left femur, and by two referred specimens, comprising an isolated dorsal vertebra and a partial left ischium. Our phylogenetic analysis recovers P. milnerae as a non-coelophysid coelophysoid theropod, representing the first-named unambiguous theropod from the Triassic of the UK. Recently, it has been suggested that Pant-y-ffynnon and other nearby Late Triassic to Early Jurassic fissure fill faunas might have been subjected to insular dwarfism. To test this hypothesis for P. milnerae , we performed an ancestral state reconstruction analysis of body size in early neotheropods. Although our results indicate that a reduced body size is autapomorphic for P. milnerae , some other coelophysoid taxa show a similar size reduction, and there is, therefore, ambiguous evidence to indicate that this species was subjected to dwarfism. Our analyses further indicate that, in contrast with averostran-line neotheropods, which increased in body size during the Triassic, coelophysoids underwent a small body size decrease early in their evolution.

Double plate fixation technique for prolonged non-weight baring induced severe disuse atrophy in hypertrophic non-union of left femur: a case report

Hypertrophic non-union differs from other forms of non-union due to its the biological capacity for union, in which it results from mechanical instability, namely the implant being unable to provide long lasting stability. Non-weight bearing state will cause bone resorption and further bone-mass loss with worsened prognosis. A 64-year-old female patient presented with inability to walk normally resulting from prolonged non-weight bearing-induced severe disuse atrophy in hypertrophic non-union of the left femur. Implant revision and osteoclasis were performed, followed by an urgent implant revision a few days later using double plating technique by placing the second plate on the anterior part of the femur. Post-operative X-ray showed satisfactory two implants placement and physiological alignment was achieved. Inappropriate initial treatment on the acute phase has led to prolonged non weight bearing state, resulting in disuse atrophy of the bone. This should have been predicted during the first implant revision on drilling both cortices, since even the slightest distraction resulted in severe consequences. Double plating system leads to absolute stability so acceptable union can be achieved. Initial treatment on acute setting of fracture should maximize every effort to restore proper functional state and should promote early mobilization. Any maltreatment will result in prolonged morbidity and will require more reconstruction effort with less than normal end result. Robust fixation and alignment can be achieved with double plating system; however, prolonged immobilization should be anticipated.