The effectiveness of percutaneous injection of expanded bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials versus autologous bone marrow concentrated, demineralized bone matrix, and platelet rich fibrin in the treatment of long bone non-unions

Obiettivo: L’obiettivo dello studio è determinare l’efficacia di una singola applicazione di cellule mesenchimali del midollo osseo espanse addizionate a granuli di fosfato tricalcico rispetto ad una singola infiltrazione con midollo osseo concentrato e matrice ossea demineralizzata. Nel Gruppo 1 sono raccolti i pazienti trattati con cellule midollari concentrate, matrice ossea demineralizzata e PRF; nel gruppo 2 sono raccolti i pazienti trattati con cellule mesenchimali espanse e granuli di fosfato tricalcico (progetto Europeo REBORN). Materiali e metodi Dal novembre 2008 al dicembre 2017 sono stati trattati 30 pazienti. I pazienti erano 17 maschi e 13 femmine, di età compresa fra 17 e 73 anni (età media 42 anni). Tra questi, 23 pazienti sono stati trattati con una singola infiltrazione con MSCs concentrate e DBM (Gruppo 1); 7 con MSCs espanse e granuli di β-TCP (Gruppo 2). La sede di trattamento era la tibia in 12 casi ed il femore in 18 casi. Risultati Dopo il primo trattamento, 17 pazienti su 23 (73%) di pazienti del Gruppo 1 potevano considerarsi guariti a fronte di 7 su 7 (100%) pazienti del Gruppo 2. Il tempo medio di guarigione è stato di 12 mesi nel Gruppo 1 (range 3 – 34 mesi) e di 6 mesi (range 3 – 8 mesi) nel Gruppo 2. Nei 7 pazienti del Gruppo 1 che non sono guariti dopo l’intervento, è stato necessario procedere alla sostituzione dei mezzi di sintesi. Dopo tale procedura, lo stato di mancata consolidazione si risolveva in un periodo di 7 mesi in media (range 6 – 12 mesi). Conclusioni Il trattamento dei ritardi di consolidazione delle ossa lunghe con MSCs espanse e granuli di fosfato tricalcico rappresenta un sistema valido nel trattamento di ritardi di consolidazione.Objective To determine the effectiveness of percutaneous injection of expanded bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials versus autologous bone marrow concentrated, demineralized bone matrix, and platelet rich fibrin in the treatment of long bone non-unions. Materials and Methods From January 2008 to January 2017, 30 patients with non-union of the lower limbs who were on the waiting list for open grafting with established tibial or femoral non-union and minimal deformity were eligible to participate in this study. Patients were divided into two groups. Twenty-three patients were treated with a single injection of autologous concentrated bone marrow, demineralized bone matrix, and platelet rich fibrin (Group 1), and 7 patients with a single injection of expanded bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials (Group 2). Results Our study group comprised 30 patients (17 males and 13 females; mean age 42, range 17 to 73). Non-unions were located in the femur (18 cases) and in the tibia (12 cases). Clinical and imaging follow-up ranged from 4 to 62 months (mean 21 months). Bone union occurred in 17 out of 23 patients (73%) on an average of 12 months (range 3 to 36) into the Group 1, and 8 out of 8 (100%) on an average of 6 months (range 3 to 8) into Group 2. No patients presented complications until the end of the follow-up. Conclusion Percutaneous injection of expanded bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials is an effective treatment for long-bone non-unions. This technique allows to get bone healing with a minimal invasive approach and with a hospitalization of 2 days. Key elements of bone regeneration consist of a combination of biological and biomechanical therapeutic approach

Periacetabular Tumour Resection under Anterosuperior Iliac Spine Allows Better Alloprosthetic Reconstruction than Above: Bone Contact Matters

Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome

DETERMINATION OF DRUG - MACROMOLECULE BINDING PARAMETERS BY NUMERICAL-ANALYSIS

A method is described for calculating the binding parameters of a drug to a macromolecule from data obtained by indirect techniques, such as spectroscopy, assuming the existence of only one class of binding sites. A critical evaluation of the performance of the method is presented, showing that the errors which previously reported methods may produce are avoided. Some examples that make use of experimental data determined for phenylbutazone and oxyphenbutazone by means of UV difference spectroscopy are given

Elastofibroma of the gluteal region with a concomitant contralateral lesion: case report and review of the literature

A 51-year-old man presented with elastofibroma (EF) of the gluteal region with a concomitant contralateral lesion. The patient presented with a slow growing mass of the proximal third of the right buttock and had swelling, discomfort in sitting, and right-hip pain during walking for 2\ua0months. On MRI, a soft-tissue mass was noted between the gluteus maximus and the gluteus medius muscle. The mass showed similar signal intensity to the surrounding tissue on T1- and T2-weighted images and with linear hyperintense areas in its internal structure. At surgery, a soft, non-encapsulated, irregular, and rubber-like mass was found attached to the gluteus medius muscles. It was pathologically confirmed to be an EF. This unusual manifestation of an EF is discussed

Can radical margins improve prognosis in primary and localized epithelioid sarcoma of the extremities?

Introduction: Epithelioid sarcoma (ES) has a tendency to locally recur, spread proximally, and metastasize, in particular to lymphnodes and lungs. The aim of this report is to study the role of surgery and the extent of margins required for optimal management of patients with localized epithelioid sarcoma of the extremities. Material and Methods: We retrospectively evaluated 77 patients affected by ES of the extremities treated at two different Institutions. Results: Twenty-two patients had metastasis at diagnosis. Estimated survival was 65.5% at 5 years and 50.9% at 10 years, with a better prognosis in patients with localized disease at diagnosis (P < 0.001). Among patients with localized disease, a significantly better survival was found in patients with primary tumors in which radical surgical margins were achieved (P = 0.043). Among 47 patients presenting with primary tumors, local recurrence-free rate was 72.9% at 5 years, and 61.9% at 10 years, with a better local control achieved in patients with radical margins were achieved (P = 0.026). Discussion: We believe that the best approach to improve both local control and survival is to aim for radical margins in patients with primary tumors. Therefore, the best chance for cure is if the first treatment is the right treatment, which we believe to be radical margins

Is the association of electrochemotherapy and bone fixation rational in patients with bone metastasis?

BackgroundBone metastases are frequent in patients with cancer. Electrochemotherapy (ECT) is a minimally invasive treatment based on a high-voltage electric pulse combined with an anticancer drug. Preclinical and clinical studies supported the use of ECT in patients with metastatic bone disease, demonstrating that it does not damage the mineral structure of the bone and its regenerative capacity, and that is feasible and efficient for the treatment of bone metastases. Year 2014 saw the start of a registry of patients with bone metastases treated with ECT, whose data are recorded in a shared database. Questions/Purposes(1) Among patients who underwent ECT and internal fixation for bone metastasis, how many experienced a reduction of pain? (2) How many cases showed a radiological response? (3) How many patients presented local or systemic complication after ECT and fixation? Patients and MethodsPatients were treated in Bologna at Rizzoli Orthopaedic Institute between March 2014 and February 2022 and recorded in the REINBONE registry (a shared database protected by security passwords): clinical and radiological information, ECT session, adverse events, response, quality of life indicators, and duration of follow-up were registered. We consider only cases treated with ECT and intramedullary nail during the same surgical session. Patients included in the analysis were 32: 15 males and 17 females, mean age 65 +/- 13 years (median 66, range 38-88 years), mean time since diagnosis of primary tumor 6.2 +/- 7.0 years (median 2.9, range 0-22 years). Nail was indicated in 13 cases for a pathological fracture in, 19 for an impending fracture. Follow-up was available for 29 patients, as 2 patients were lost to follow-up and 1 was unable to return to controls. Mean follow-up time was 7.7 +/- 6.5 months (median 5, range 1-24), and 16 patients (50%) had a follow-up longer than 6 months. ResultsA significant decrease in pain intensity was observed at the mean Visual Numeric Scale after treatment. Bone recovery was observed in 13 patients. The other 16 patients remained without changes, and one presented disease progression. One patient presented a fracture occurrence during the ECT procedure. Among all patients, bone recovery was observed in 13 patients: complete recovery in 1 patient (3%) and partial recovery in 12 patients (41%). The other 16 patients remained without changes, and one presented disease progression. One patient presented a fracture occurrence during the ECT procedure. However, healing was possible with normal fracture callus quality and healing time. No other local or systemic complications were observed. ConclusionWe found that pain levels decreased after treatment in 23 of the 29 cases for a pain relief rate of 79% at final follow-up. Pain is one of the most important indicators of quality of life in patients that undergo palliative treatments. Even if conventional external body radiotherapy is considered a noninvasive treatment, it presents a dose-dependent toxicity. ECT provides a chemical necrosis preserving osteogenic activity and structural integrity of bone trabeculae; this is a crucial difference with other local treatments and allows bone healing in case of pathological fracture. The risk of local progression in our patient population was small, and 44% experienced bone recovery while 53% of the cases remained unchanged. We observe intraoperative fracture in one case.This technique, in selected patients, improves outcome in bone metastatic patients combing both the efficacy of the ECT in the local control of the disease and the mechanical stability with the bone fixation to synergize their benefits. Moreover, the risk of complication is very low. Although encouraging data, comparative studies are required to quantify the real efficacy of the technique. Level of Evidence Level I, therapeutic study