En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature

<p>Abstract</p> <p>Introduction</p> <p>Giant cell tumor (GCT) of distal radius follows a comparatively aggressive behaviour. Wide excision is the management of choice, but this creates a defect at the distal end of radius. The preffered modalities for reconstruction of such a defect include vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We here present our experience with wide resection and non-vascularised autogenous fibula grafting for GCT of distal radius.</p> <p>Materials and methods</p> <p>Twelve patients with a mean age of 34.7 years (21-43 years) with Campanacci Grade II/III GCT of distal radius were managed with wide excision of tumor and reconstruction with ipsilateral nonvascularised fibula, fixed with small fragment plate to the remnant of the radius. Primary autogenous iliac crest grafting was done at the fibuloradial junction in all the patients.</p> <p>Results</p> <p>Mean follow up period was 5.8 years (8.2-3.7 years). Average time for union at fibuloradial junction was 33 weeks (14-69 weeks). Mean grip strength of involved side was 71% (42-86%). The average range of movements were 52° forearm supination, 37° forearm pronation, 42° of wrist palmerflexion and 31° of wrist dorsiflexion with combined movements of 162°. Overall revised musculoskeletal tumor society (MSTS) score averaged 91.38% (76.67-93.33%) with five excellent, four good and three satisfactory results. There were no cases with graft related complications or deep infections, 3 cases with wrist subluxation, 2 cases with non union (which subsequently united with bone grafting) and 1 case of tumor recurrence.</p> <p>Conclusion</p> <p>Although complication rate is high, autogenous non-vascularised fibular autograft reconstruction of distal radius can be considered as a reasonable option after en bloc excision of Grade II/III GCT.</p

Fresh Water Cyanobacteria Geitlerinema sp. CCC728 and Arthrospira sp. CCC729 as an Anticancer Drug Resource.

An increasing number of cancer patients worldwide, especially in third world countries, have raised concern to explore natural drug resources, such as the less explored fresh water filamentous cyanobacteria. Six strains of cyanobacteria (Phormidium sp. CCC727, Geitlerinema sp. CCC728, Arthrospira sp. CCC729, Phormidium sp. CCC731, Phormidium sp. CCC730, and Leptolyngbya sp. CCC732) were isolated (paddy fields and ponds in the Banaras Hindu University, campus) and five strains screened for anticancer potential using human colon adenocarcinoma (HT29) and human kidney adenocarcinoma (A498) cancer cell lines. Geitlerinema sp. CCC728 and Arthrospira sp. CCC729 were the most potent as determined by examination of morphological features and by inhibition of growth by graded concentrations of crude extracts and thin-layer chromatography (TLC) eluates. Cell cycle analysis and multiplex assays using cancer biomarkers also confirmed Geitlerinema sp. CCC728 and Arthrospira sp. CCC729 as cancer drug resources. Apoptotic studies in the cells of A498 (cancer) and MCF-10A (normal human epithelial) exposed to crude extracts and TLC fractions revealed no significant impact on MCF-10A cells emphasizing its importance in the development of anticancer drug. Identification of biomolecules from these extracts are in progress

Screening for anticancer activity on cancer cell line.

<p>Calcein assay using a renal cell carcinoma (A498) cell line. Significant difference (p<0.001) between pairs, control with <i>Geitlerinema</i> CCC728 and <i>Arthrospira</i> CCC729 <b>(a),</b> Control, C2 and C3 with C4 and C5 <b>(b)</b> and Control and D1 with D3 and D4, D2 with D4 <b>(c)</b>. Control was lacking with crude extracts or TLC fractions.</p

Phylogenetic tree of 16S rRNA gene in cyanobacteria generated through BLASTN search in NCBI cyanobacterial database using the neighbor joining algorithm provided by MEGA 5.

<p>Phylogenetic tree of 16S rRNA gene in cyanobacteria generated through BLASTN search in NCBI cyanobacterial database using the neighbor joining algorithm provided by MEGA 5.</p

Apoptotic analysis by Flow cytometry using Annexin V-PI.

<p>A498 as well as MCF-10A cells were exposed to TLC fractions C4 and C5 (<i>Geitlerinema</i> sp. CCC728), D3 and D4 (<i>Arthrospira</i> sp. CCC729). Statistical analysis of A498 cell lines under treatment showed significant impact on cancer cells (F_4,10 = 106.582, p<0.001) <b>(a).</b> As far as MCF-10A cells were concerned they were not significantly affected by fractions selected in experiment (F_4,10 = 2.588, p> 0.05) <b>(b).</b></p

Screening for anticancer activity on MCF10A cell line.

<p>Effects of crude extracts and TLC fractions on normal human mammary epithelial (MCF10A) cells. Significant difference (p<0.001) between pairs, control with <i>Geitlerinema</i> CCC728 and <i>Arthrospira</i> CCC729 crude extracts <b>(a),</b> no significant difference (p>0.05) among pairs control and C2 and C3, C4 as well as C5 <b>(b)</b> and significant difference (p<0.05) among control with D2 with D3 and no significant difference (p>0.05) among pairs control with D1 and D4 <b>(c)</b>.</p

Effect of <i>Arthrospira</i> sp. CCC729 crude extract on selected cancer biomarkers.

<p>Multiplex assay showing levels of expression of cancer biomarkers in A498 cancer cells after treatment with crude extract at 100 μg·mL^-1 in the cells.</p

<i>Geitlerinema</i> sp. CCC728 crude extract has no effect on some cancer biomarkers.

<p>Multiplex assay showing levels of expression of cancer biomarkers in A498 cancer cells after treatment with crude extract at 100 μg·mL^-1 in the cells showing no impact on selected biomarkers.</p

Cell cycle analysis of A498 cell lines with PI staining using Flow cytometry.

<p>Interaction of cells with most potent fractions from the second TLC purification: control cells without treatment (a), cells <i>vs</i> D3 <b>(b)</b> and D4 <b>(c) from</b><i>Arthrospira</i>, C4 <b>(c)</b> and C5 <b>(d)</b> from <i>Geitlerinema</i>.</p