It is becoming apparent that mesenchymal stem cells (MSCs) do not directly contribute to mesenchymal tissue regeneration. Pre-clinical attempts to repair large bone defects in big animal models have been hampered by poor MSCs survival after implantation which impedes their direct or indirect effects. Based on previous work, we hypothesized that a venous axial vascularization of the scaffold supporting MSCs or their combination with fresh bone marrow (BM) aspirate would improve their in vivo survival. Cross-shape profile tubular microporous monetite implants (12mm long, 5mm large) as two longitudinal halves were produced by 3D powder printing. They were implanted around the femoral veins of Wistar rats and loaded with 1mL of BM aspirate either alone or supplemented by 107 MSCs. This was compared with BM-free scaffolds loaded only with 107 MSCs. After 8 weeks bone formation were investigated by micro-CT, scanning electron microscopy, histology and immunohistochemistry.Abstract
Purpose
Methods
The aim was to analyze the efficacy of zoledronic acid (ZA) versus denosumab in the prevention of pathological fractures in patients with bone metastases from advanced cancers by evaluating all available randomized controlled trials (RCTs) on this subject. A systematic search of electronic databases (PubMed and MEDLINE) was performed to identify all published RCTs comparing zoledronic acid with denosumab in prevention of pathological fractures in bone metastases. Risk of bias of the studies was assessed. The primary outcomes evaluated were pathological fractures. Four RCTs (7320 patients) were included. Denosumab was superior to ZA in reducing the likelihood of pathological fractures, when all tumour types were combined (OR 0.86, 95% CI [0.74, 0.99], Denosumab significantly reduces the likelihood of pathological fractures in comparison to ZA in patients with bone metastases. When pathological fractures were grouped by tumour origin (endodermal or mesodermal), there was no significant difference between denosumab and ZA. Further long-term studies are needed to confirm the effectiveness of these treatment regimens.
The aim was to analyze whether non-steroidal anti-inflammatory drugs (NSAIDs) have an adverse effect on bone healing by evaluating all available human randomized controlled trials (RCTs) on this subject. A systematic search of electronic databases (PubMed, MEDLINE, and Cross-References) was performed to identify RCTs comparing the occurrence of nonunion in patients who received NSAIDs to the control group. Risk of bias of the studies was assessed. Nonunion was the main outcome evaluated, however, regression analysis was used to estimate the relative risk comparing duration and type of NSAIDs. Six RCTs (609 patients) were included. The risk of nonunion was higher in the patients given NSAIDs after the fracture (P-value= 0.0009, relative risk [RR] = 2.9, 95% confidence interval [CI] = 1.6 to 6.3). However, once the studies have been categorized to the duration of NSAIDs, those who received short period of NSAIDs (4 weeks) (P-value = 0.0002, RR = 4.1, CI = 2.1 to 8). Also, indomethacin agent has associated with high nonunion (P-value = 0.0001, RR = 3.9, CI = 2.3 to 13.9) compared to other NSAIDs which did not show a nonunion risk (P-value = 0.24, RR = 2.3, CI = 0.6 to 8.9). Using NSAIDs for long period (> 4 weeks) after fracture is significantly associated with nonunion especially with indomethacin agent. However, short period of NSAIDs (< 2 weeks) did not show the adverse effects of nonunion. Overall, further studies are required to support our conclusion.
to determine the extent of Orthobullets use by orthopaedic residents in academic and clinical settings. We also wanted to determine whether its widespread use is the same in various training programs around the world and so we chose to survey two distinct programs without any academic or institutional ties. An electronic 9 question survey created using SurveyMonkey was sent to residents in two distinct Orthopaedic residency programs, either via text message or by email. The two programs surveyed were the McGill University Orthopaedic Surgery residency program located in Montreal, Canada, and the Oman Medical Specialty Board (OMSB) Orthopaedic Surgery residency program located in Muscat, Oman. A total of 36 residents, 20 from McGill and 16 from OMSB, responded to the survey request. In both programs, 89% of all the residents surveyed claimed they use Orthobullets at least 4 times per week, and greater than 95% of them use it during call shifts to obtain information rapidly. Regarding the use of Orthobullets in the context of operating theatre case preparation, over 50% of residents claim to use it often while only 25% claim to rarely use it for this purpose. The use of Orthobullets during clinics seemed to be the least popular among residents as 47% claimed they rarely use it. Cumulatively in both programs, more than 80% of residents indicated that they always use Orthobullets in preparation for an exam especially among senior residents. Approximately two thirds of residents have said they completely trust the information provided on Orthobullets, with the remainder indicating that they trust Orthobullets more than 75% of the time. The proportion of residents who indicated that they completely trust Orthobullets was greater in the OMSB group (75%) and among senior trainees. Over 85% of residents discovered Orthobullets through friends and colleagues, and the rest through the program and faculty members. Our survey results demonstrate the widespread use of Orthobullets, a popular online orthopaedic resource, among orthopaedic residents of all levels. The settings in which Orthobullets was most used were exam preparation and during call shifts. In addition, with the high amount of confidence residence have Orthobullets, it is questionable as to how many are actually aware that its information is not validated. For the time being however, we do not discourage the use of Orthobullets for exam preparation, however, we recommend that programs warn their residents to abstain from using it in their clinical decision-making until it has demonstrated peer-reviewed approval.
