Resection Of Osteosarcoma Research Articles

Interaction of basic diseases and low red blood cell count as critical murderer of wound infection after osteosarcoma resection: Wound infection after osteosarcoma resection.

Background:Surgical wound infection is one of the common complications in patients after osteosarcoma resection. It is imperative to grasp the risk factors comprehensively. Therefore, this study aimed to explore the risk factors of wound infection and deeply analyze the correlation between risk factors and wound infection.Methods:The study subjects were 101 patients who underwent osteosarcoma resection between April 2018 and August 2021. The diagnosis of postoperative wound infection was confirmed by postoperative observation of the incision, ultrasound imaging, and pathogenic examination. This study included a series of potential factors, mainly laboratory examination indicators and patients’ general information. The statistical methods had Pearson Chi-square test, Spearman-rho correlation test, multifactorial linear regression model, logistic regression analysis, and receiver operating characteristic (ROC) curve.Results:Pearson Chi-square test and Spearman correlation test showed that red blood cell (RBC) count (P = .033) and basic diseases (P = .020) were significantly correlated with a surgical wound infection after osteosarcoma resection. Logistic regression analysis manifested that basic disease (OR = 0.121, 95% CI: 0.015‐0.960, P = .046) and RBC (OR = 0.296, 95% CI: 0.093‐0.944, P = .040) have a clear correlation with whether the patients have surgical wound infection after osteosarcoma resection. And the interaction of basic diseases and RBC could diagnose the surgical wound infection sensitively and accurately (AUC = 0.700, P = .014, 95% CI = 0.564‐0.836) via the ROC analysis.Conclusion:Patients with basic diseases and low RBC were risk factors for surgical wound infection after osteosarcoma resection.

Developing a Versatile Multiscale Therapeutic Platform for Osteosarcoma Synergistic Photothermo-Chemotherapy with Effective Osteogenicity and Antibacterial Capability.

Osteosarcoma is a devastating malignant neoplasm that seriously threatens human health. After an osteosarcoma resection, the simultaneous treatment of tumor recurrence, postoperative infection, and large bone loss remains a formidable challenge clinically. Herein, a versatile multiscale therapeutic platform (Fs-BP-DOX@PDA) is engineered based on NiTi alloys with versatile properties for near-infrared (NIR)-mediated osteosarcoma synergistic photothermo-chemotherapy, bone regeneration, and bacterial elimination. First, an intriguing method for fabricating groovelike micro-nanostructures (Fs-NiTi) through femtosecond laser direct writing to enhance osseointegration with strong contact guidance is proposed. Then, black phosphorus (BP) nanosheets as gratifying photothermal conversion agents, osteogenetic agents, and a drug delivery platform are decorated on Fs-NiTi to construct multiscale hierarchical structures (Fs-BP). Finally, the polydopamine (PDA) modification is utilized to enhance the photothermal performance, biocompatibility, and chemical stability of doxorubicin (DOX)-loaded Fs-BP and endow NIR/pH-dual-responsive DOX release properties. Fs-BP-DOX@PDA effectively induces tumor cell (Saos-2 and MDA-MB-231) death in vitro, completely eradicates osteosarcoma in mice, and observably promotes bone-regeneration bioactivity. Furthermore, it possesses prominent antibacterial efficiencies toward Staphylococcus aureus (99.2%) and Pseudomonas aeruginosa (99.6%). Overall, this work presents a smart comprehensive fabrication methodology to construct a versatile multiscale therapeutic platform for multimodal osteosarcoma treatment and biomedical tissue engineering.

Charge transfer of ZnTPP/C60 cocrystal-hybridized bioimplants satisfies osteosarcoma eradication with antitumoral, antibacterial and osteogenic performances

Inferior bone-tissue regeneration, rapid tumor recurrence, and severe bacterial infection are the dominating challenges of osteosarcoma resection, which result in the failure of surgical intervention, and even amputation in serious circumstances. Herein, the multifunctional scaffolds (termed as ZCBS) are elaborately designed by in-situ integration of two-dimensional (2D) cocrystals with bioactive-glass scaffolds (BS) for significant osteosarcoma ablation, bacterial sterilization, and neo-bone regeneration. The efficient charge transfer between electron donor (zinc (II) tetraphenylporphyrin, ZnTPP) and acceptor (fullerene, C60) molecules of 2D cocrystals facilitates ZCBS with prominent photothermal-conversion performance for osteosarcoma elimination and bacterial eradication. Meanwhile, the gradual release of C60 and Zn2+ is beneficial to the reinforced antibacterial capability of ZCBS. Furthermore, the macropore structures and progressive release of Zn2+, Ca2+, and PO43- endow ZCBS with excellent osteogenic performance in promoting bone-tissue regeneration. Collectively, the engineered ZCBS bioscaffolds feature intrinsically multifunctional properties including antitumor, antibacterial, and osteogenic bioactivities, which support ZCBS for efficient osteosarcoma eradication, antibacterial treatment, and bone-tissue regeneration both in vitro and in vivo. Therefore, the developed “cocrystal engineering” strategy towards ZCBS with multifunctional bioactivities offer a competitive approach for osteosarcoma- and bacterial infection-induced bone regeneration.

3D printing for surgical planning of canine oral and maxillofacial surgeries

BackgroundAdvanced diagnostic imaging is an essential part of preoperative planning for oral and maxillofacial surgery in veterinary patients. 3-dimensional (3D) printed models and surgical guides generated from diagnostic imaging can provide a deeper understanding of the complex maxillofacial anatomy, including relevant spatial relationships. Additionally, patient-specific 3D printed models allow surgeons and trainees to better examine anatomical features through tactile and visuospatial feedback allowing for improved preoperative planning, intraoperative guidance, and enhanced trainee education. Furthermore, these models facilitate discussions with pet owners, allowing for improved owner understanding of pathology, and educated decision-making regarding treatment.Case presentationOur case series consists of three 3D printed models segmented from computed tomography (CT) and cone beam CT (CBCT) and fabricated via desktop vat polymerization for preoperative planning and intraoperative guidance for resection of maxillary osteosarcoma, mandibular reconstruction after mandibulectomy, and gap arthroplasty for temporomandibular joint ankylosis in dogs.ConclusionsWe illustrate multiple benefits and indications for 3D printing in veterinary oral and maxillofacial surgery. 3D printed models facilitate the understanding of complex surgical anatomy, creating an opportunity to assess the spatial relationship of the relevant structures. It facilitates individualized surgical planning by allowing surgeons to tailor and augment the surgical plan by examining patient-specific anatomy and pathology. Surgical steps may also be simulated in advance, including planning of osteotomy lines, and pre-contouring of titanium plates for reconstruction. Additionally, a 3D printed model and surgical guide also serve as invaluable intraoperative reference and guidance. Furthermore, 3D printed models have the potential to improve veterinary resident and student training as well as pet owner understanding and communication regarding the condition of their pets, treatment plan and intended outcomes.

Use of Nomogram on Nutritional Assessment Indicators to Predict Clinical Outcomes in Patients Undergoing Surgical Resection for High-Grade Osteosarcoma

Background: To evaluate the prognostic values of nutrition-associated indicators and develop nutritional models for prediction of different clinical outcomes in patients with high-grade osteosarcoma receiving surgical resection. Methods: Patients diagnosed as high-grade osteosarcomas were included between 2008 and 2018. Body mass index (BMI), Glasgow prognostic score (GPS), systematic inflammatory index (SII), and controlling nutritional score (CONUT) were calculated as nutrition-associated indicators. The primary outcome was overall survival (OS) as the long-term outcome, and the secondary outcome was the postoperative hospitalization duration as the short-term outcome. The prognostic values of nutrition-associated indicators were evaluated by univariate and multivariate analyses to recognize the potential predictors for construction of nomogram model with validation. Results: High GPS and CONUT yielded poor OS independently [GPS: HR (95% CI): 3.262 (2.035–5.229), p < 0.001; CONUT: HR (95% CI): 2.445 (1.508–3.964), p < 0.001]. The nomogram model for OS showed great prediction abilities and moderate calibration performance after integrating GPS and CONUT. CONUT was also identified as the independent predictor for hospitalization duration [OR (95% CI): 1.950 (1.145–3.321), p = 0.014]. Conclusions: The CONUT score was considered as the significant predictor in prediction of OS and hospitalization duration. Appropriate management for nutritional status might optimize patients’ prognoses with reference to nutrition-associated indicators.

Supercritical Fluid-Assisted Fabrication of PDA-Coated Poly (l-lactic Acid)/Curcumin Microparticles for Chemo-Photothermal Therapy of Osteosarcoma

After traditional osteosarcoma resection, recurrence of tumor is still a major clinical challenge. The combination of chemotherapy and photothermal therapy (PTT) has great potential in improving therapeutic effect. However, the studies using polydopamine (PDA) as photothermal transducing agent to improve the anti-cancer activity of curcumin (CM)-loaded poly (l-lactic acid) (PLLA) microparticles (PLLA/CM) have seldom been investigated. In this study, we reported the synthesis of PDA-coated PLLA/CM microparticles (PDA-PLLA/CM) prepared by PDA coating on the surface of the PLLA/CM microparticles fabricated by solution-enhanced dispersion by supercritical CO2 (SEDS) for chemo-photothermal therapy of osteosarcoma. The average particle sizes of PLLA/CM and PDA-PLLA/CM microparticles with a spherical shape were (802.6 ± 8.0) nm and (942.5 ± 39.5) nm, respectively. PDA-PLLA/CM microparticles exhibited pH- and near-infrared (NIR)-responsive release behavior to promote CM release in the drug delivery system. Moreover, PDA-PLLA/CM microparticles displayed good photothermal conversion ability and photothermal stability attributed to PDA coating. Additionally, the results of in vitro anti-cancer experiment showed that 500 μg/mL PDA-PLLA/CM microparticles had good anti-cancer effect on MG-63 cells and no obvious toxicity to MC3T3-E1 cells. After incubation with PDA-PLLA/CM microparticles for 2 days, NIR irradiation treatment improved the anti-cancer activity of PDA-PLLA/CM microparticles obviously and reduced the cell viability of osteosarcoma from 47.4% to 20.6%. These results indicated that PDA-PLLA/CM microparticles possessed a synergetic chemo-photothermal therapy for osteosarcoma. Therefore, this study demonstrated that PDA-PLLA/CM microparticles may be an excellent drug delivery platform for chemo-photothermal therapy of tumors.

Intramedullary Fixation of Double-Barrel Vascularised Fibula Grafts With Subsequent Lengthening for Reconstruction of the Distal Femur in Patients With Osteosarcoma.

The use of vascularised fibula grafts is an accepted method for reconstructing the distal femur following resection of malignant childhood tumors. Limitations relate to the mismatch of the cross-sectional area of the transplanted fibula graft and the local bone, instability of the construct and union difficulties. We present midterm results of a unique staged technique-an immediate defect reconstruction using a double-barrel vascularised fibula graft set in in A-frame configuration and a subsequent intramedullary femoral lengthening. We retrospectively included 10 patients (mean age 10 y) with an osteosarcoma of the distal femur, who were treated according to the above-mentioned surgical technique. All patients were evaluated with regards to consolidation of the transplanted grafts, hypertrophy at the graft-host junctions, leg length discrepancies, lengthening indices, complications as well as functional outcome. The mean defect size after tumor resection was 14.5 cm, the mean length of the harvested fibula graft 22 cm, resulting in a mean (acute) shortening of 4.7 cm (in 8 patients). Consolidation was achieved in all cases, 4 patients required supplementary bone grafting. Hypertrophy at the graft-host junctions was observed in 78% of the evaluable junctions. In total 11 intramedullary lengthening procedures in 9 patients had been performed at the last follow up. The mean Muskuloskeletal Society Rating Scale (MSTS) score of the evaluable 9 patients was 85% (57% to 100%) with good or excellent results in 7 patients. A-frame vascularised fibula reconstructions showed encouraging results with respect to defect reconstruction, length as well as function and should therefore be considered a valuable option for reconstruction of the distal femur after osteosarcoma resection. The surgical implementation is demanding though, which is emphasized by the considerable high number of complications requiring surgical intervention, even though most were not serious. Level IV-case series.

Development of self-powered multifunctional piezomagnetic nanoparticles for non-invasive post-surgical osteosarcoma theranogeneration

Non-invasive treatment approaches are gaining increased attention in recent times due to the potential improvement in treatment efficiency. Here we report a brand-new ultrasound (US), magnetic field (MF), and light responsive nanoparticle system based on piezoelectric barium titanate and superparamagnetic iron oxide nanoparticles termed as PiezoMagnetic nanoparticles (PMNPs) for the multimodal anticancer treatment, complimentary imaging, and non-invasive cell stimulation. Systematic electrical studies reveal that PMNPs exhibit superior ferroelectric and conducting properties and produce electrical signals analogous to native tissues when mechanically stimulated and using Food and Drug Administration (FDA) approved Low intensity Pulsed Ultrasound (LIPUS) non-invasively for cell stimulation. The green energy generation from PMNPs are further proved by the real-time demonstration of commercial LED lit-up. Thus, as a proof of concept, we have demonstrated a stepwise treatment efficacy of PMNPs for the post-surgical osteosarcoma therapy, diagnosis, and regeneration (termed as Theranogeneration). The PMNPs exhibited excellent anticancer properties to eradicate the residual osteosarcoma cells by magnetic hyperthermia, photothermal and photodynamic therapy along with complimentary imaging capabilities as X-ray computed tomography contrast agent and label free fluorescent probe. The conjugation of risedronate R (RIS)- a new generation bisphosphonates to PMNPs imparted bone seeking property to PMNPs. Therefore, as a result of noninvasive cell stimulation properties of PMNPs under LIPUS and LIPUS mediated RIS release from PMNPs resulted in enhanced bone regeneration and bone turnover which helps to repair the large bone defects occurs in osteosarcoma resection. Thus, the study corroborates the development of a potential bioactive piezoelectric nanoplatform that can be used to control the cell behaviour and fate in order to develop new types of therapies for multiple diseases including various types of cancers in remotely controlled approaches.

“In-house” Design and Use of 3-dimensional Printed Patient-specific Bone Tumor Resection Guides for Geometric Osteotomies in Sarcoma Surgery

Three-dimensional printing technology has rapidly advanced as a promising technology for preoperative planning, education, and surgical execution in orthopedic surgery. Use of patient-specific instrumentation in orthopedic oncology sarcoma cases can streamline complex osteotomies while providing safe margins based on predetermined osteotomy levels. We describe use of an “in-house” protocol to create patient-specific bone tumor resection guides for use in orthopedic oncology cases. The described protocol bypasses expensive outsourcing options and facilitates use of preoperative surgical simulation and intimate involvement of the surgical team in the guide design. We report on the successful design and use of three-dimensional printed patient-specific bone tissue resection guides in a case of proximal tibial parosteal osteosarcoma resection and reconstruction with a size-matched allograft, and in a case of a secondary pelvic chondrosarcoma resection.

Prosthetic replacement after resection of osteosarcoma of the proximal femur: a case report

Prosthetic replacement after resection of osteosarcoma of the proximal femur: a case report

Serum level of miR-217 predicts prognostic outcome for osteosarcoma patients in China

In this study, we aimed to investigate the expression of miR-217 in osteosarcoma and adjacent tissues, and its relationship with clinical features, and thus provide a scientific basis for the diagnosis and treatment of osteosarcoma. Sixty patients with osteosarcoma who underwent radical osteosarcoma resection in our hospital in China from January to December 2015 were selected. Real-time reverse transcription PCR (qRT-PCR) was used to detect the expression of miR-217 in osteosarcoma and parasarcoma tissues. Its correlation with clinical data and prognosis of patients was analyzed. Our results showed that the average expression level of miR-217 in osteosarcoma tissues (2.94 ± 0.79) was higher than that of parasarcoma tissues (2.14 ± 0.66) (P <0.05). The difference between the expression level of miR-217 in osteosarcoma tissue and pathological grade (P = 0.034) and clinical stage (P = 0.007) was statistically significant. Cox multivariate analysis showed that clinical stage (HR = 4.135, 95% CI = 1.682-6.236) and miR-217 (HR = 3.764, 95% CI = 1.572-5.921) are independent risk factors that affect the prognosis of osteosarcoma (P < 0.05). In conclusion, miR-217 plays a key regulatory role in the occurrence and progression of osteosarcoma. Serum miR-217 levels can predict the prognosis of osteosarcoma patients.

Designing a better incision for proximal tibial osteosarcoma resection and reconstruction: a reminder of the skin's vascular anatomy.

Designing a better incision for proximal tibial osteosarcoma resection and reconstruction: a reminder of the skin's vascular anatomy.

Synthesis of curcumin and indocyanine green co-loaded PLLA microparticles via solution-enhanced dispersion using supercritical CO2 for chemo-photothermal therapy of osteosarcoma

The therapy of tumor recurrence resulting from surgical resection of osteosarcoma is still a significant challenge for clinicians. In this study, we designed curcumin (CM) and indocyanine green (ICG) co-loaded poly(L-lactic acid) (PLLA) (PLLA-CM-ICG) composite microparticles, combining photothermal therapy with chemotherapy to enhance osteosarcoma therapy synergistically. PLLA-CM-ICG microparticles of sizes of (838.3 ± 5.4) nm were prepared by solution-enhanced dispersion by a supercritical CO2 process. ICG in the PLLA-CM-ICG microparticles was more stable than free ICG. The PLLA-CM-ICG microparticles displayed pH- and near-infrared (NIR)-responsive CM release behavior. Moreover, NIR irradiation improved the anticancer activity of the PLLA-CM-ICG microparticles at a concentration of 250 μg/mL on MG-63 cells. Therefore, PLLA-CM-ICG microparticles could be employed as promising drug delivery systems for synergic photothermo-chemotherapy in osteosarcoma treatment.

Engineering a multiscale multifunctional theragenerative system for enhancing osteosarcoma therapy, bone regeneration and bacterial eradication

Osteosarcoma as an aggressive malignant neoplasm is one of the formidable challenging diseases clinically. The related tumor recurrence, large bone defects, and postoperative bacterial infection after surgical resection of osteosarcoma are pressing problems that still threaten patient health. Herein, a multiscale multifunctional theragenerative system (Fs-NFs-AuPt) is designed based on NiTi alloys for near-infrared-activated photothermal ablation of osteosarcoma, bone repair, and antibacterial. To achieve this aim, first, a useful methodology is proposed that employs temporally shaped femtosecond laser ablation combined with hydrothermal synthesis to fabricate multiscale hierarchical structures (Fs-NFs) consisting of three-dimensional micro-nanostructures (Fs-NiTi) and nanoflower-like structures (NFs) for promoting osteogenicity. Then, AuPt bimetallic nanoparticles as satisfactory photothermal therapy agents and osteoinductive agents are rapidly (only need 30 s) one-step in-situ synthesized on Fs-NFs through ultraviolet photoreduction without any reductant. Fs-NFs-AuPt significantly ablates tumors cells (Saos-2 and MDA-MB-231) in vitro, effectively inhibits osteosarcoma growth in mice, and positively induces the osteogenesis of osteoblasts (MC3T3-E1). Moreover, it exhibits superior antibacterial efficiencies of 99.5% and 99.8% against Staphylococcus aureus and Pseudomonas aeruginosa, respectively. Overall, this work offers a high-efficiency, high-quality, and high-repeatability distinctive integrated fabrication avenue to construct a multiscale multifunctional theragenerative system for osteosarcoma therapy and bone-tissue engineering.

Biomimetic Polydopamine-Modified Silk Fibroin/Curcumin Nanofibrous Scaffolds for Chemo-photothermal Therapy of Bone Tumor.

The simultaneous therapy of tumor recurrence and bone defects resulting from surgical resection of osteosarcoma is still a challenge in the clinic. Combination therapy based on a localized drug-delivery system shows great promise in the treatment of osteosarcoma. Herein, bifunctional polydopamine (PDA)-modified curcumin (CM)-loaded silk fibroin (SF) composite (SF/CM-PDA) nanofibrous scaffolds, which combined photothermal therapy with chemotherapy to synergistically enhance osteosarcoma therapy, were prepared by PDA coating of the SF/CM nanofibrous scaffolds fabricated by supercritical carbon dioxide (SC-CO2) technology. The PDA coating improved hydrophilicity and mechanical strength of the SF/CM scaffolds. The SF/CM-PDA scaffolds present good photothermal conversion capacity and excellent photostability. The low pH and near-infrared (NIR) irradiation could effectively accelerate release of CM in the SF/CM-PDA scaffolds. The in vitro anticancer results indicated that the biocompatible SF/CM-PDA scaffolds had a long-term, stable, and superior anticancer effect compared to pure CM. Furthermore, the SF/CM-PDA scaffolds significantly increased the growth inhibition of osteosarcoma MG-63 cells under NIR irradiation (808 nm and 1.3 W/cm2). Besides, the SF/CM-PDA scaffolds could enhance osteoblast MC3T3-E1 cell proliferation in vitro when the mass ratio of CM was 0.05–0.5%. This work has therefore demonstrated that the bifunctional SF/CM-PDA scaffolds provide a competitive strategy for local osteosarcoma therapy and bone regeneration.

Comparable outcomes of recycled autografts and allografts for reconstructions in patients with high-grade osteosarcoma.

This retrospective, single-centre study compares the clinical and radiographic outcomes of limb reconstruction using recycled autografts to that using allografts. Patients with histopathologically verified high-grade osteosarcoma treated with wide bone resection and limb reconstruction using allografts or recycled autografts from January 1998 through December 2012 were retrospectively screened for enrolment eligibility. The final study cohort included 255 patients (allograft, 91; recycled autograft, 164). Data regarding post-operative complications, salvage treatment, and graft survival were collected. A modified International Society of Limb Salvage classification system was used to evaluate the radiographic findings. The time to graft-host union did not differ significantly between the two graft types. Patients receiving recycled autografts had fewer complications compared than did those receiving allografts (recycled autografts vs. allograft: structural failure, 4.3 vs. 13.2%; late infection, 2.4 vs. 7.7%; all p < 0.05). Complications occurred most frequently during the first three years after surgery, and the majority were manageable. The five year limb survival rate did not differ significantly between the two graft types (91.3 vs. 94.0%; p = 0.752). No local oncological recurrence was observed within the recycled autografts. Recycled autografts and allografts are feasible options for biological limb reconstructions in terms of complications and graft survival after wide resection of osteosarcoma.

Impact of Surgical Resection and Reasons for Poor Prognosis of Pelvic Osteosarcoma Based on the Bone Tumor Registry in Japan.

Simple SummaryPelvic osteosarcoma has a poor prognosis compared to osteosarcomas in other locations, and the reasons for this remains unknown. Surgical resection of pelvic osteosarcoma is technically demanding and often results in dysfunction and complications. In this study, we investigated the reasons underlying the poor prognosis of pelvic osteosarcoma by comparing it to femoral osteosarcoma using data from the Bone Tumor Registry in Japan. We used propensity score analysis to determine whether surgical resection of pelvic osteosarcoma improved its prognosis. We demonstrated that pelvic osteosarcoma had a poor prognosis because it occurred more often in the elderly, often had a larger tumor size, and had metastasis at presentation more often in comparison to femoral osteosarcoma. These three factors were also associated with the non-surgical treatment of pelvic osteosarcoma, which also led to a poor outcome. The overall survival rate was only comparable in pelvic osteosarcoma and femoral osteosarcoma in cases treated with surgical resection. Propensity score analysis revealed that surgical treatment improved the prognosis of pelvic osteosarcoma. As such, we propose that surgical resection should be considered based on tumor stage and patient age in order to improve the prognosis of pelvic osteosarcoma.Pelvic osteosarcoma has a poor prognosis compared to osteosarcomas in other locations, and the reasons for this remain unknown. Surgical resection of pelvic osteosarcoma is technically demanding and often results in dysfunction and complications. In this study, we investigated the reasons underlying the poor prognosis of pelvic osteosarcoma by comparing it to femoral osteosarcoma using data from the Bone Tumor Registry in Japan. We used propensity score analysis to determine whether surgical resection of pelvic osteosarcoma improved its prognosis. We demonstrated that pelvic osteosarcoma had a poor prognosis because it occurred more often in the elderly, often had larger tumor size, and had metastasis at presentation more often in comparison to femoral osteosarcoma. These three factors were also associated with the non-surgical treatment of pelvic osteosarcoma, which also led to a poor outcome. The overall survival rate was only comparable in pelvic osteosarcoma and femoral osteosarcoma in cases treated with surgical resection. Propensity score analysis revealed that surgical treatment improved the prognosis of pelvic osteosarcoma. As such, we propose that surgical resection should be considered based on tumor stage and patient age in order to improve the prognosis of pelvic osteosarcoma.

The Application of 3D-Printing and Nanotechnology for the Targeted Treatment of Osteosarcoma

Osteosarcoma is a malignant bone neoplasm prevalent in adolescents. Current therapies include chemotherapy and surgery. Surgical resection of osteosarcoma induces a large bone defect which may be overcome by employing scaffolds for bone tissue engineering. This review details the polymers and bioceramics that may be used to fabricate 3D printed scaffolds for bone regeneration and the nanotechnology strategies that may be incorporated into such scaffolds. Natural polymers discussed include chitosan, alginate, collagen, gelatin, and silk fibroin. Synthetic polymers discussed include polycaprolactone, polyurethane, poly(lactic)acid and poly(vinyl) alcohol. Bioceramics that are utilized in bone regeneration such as calcium phosphate, calcium silicate and bioglass are elaborated on. Furthermore, comparison data between different types of 3D printed scaffolds for bone regeneration are presented. A discussion on Photo-responsive and magneto-responsive 3D printed scaffolds that have been fabricated for bone regeneration is included. Research concerning drug-loaded scaffolds as well as the incorporation of nanocarriers into scaffolds for bone regeneration is provided. Chemotherapy utilized in osteosarcoma therapy has severe adverse effects due to being non-selective between healthy cells and tumor cells. A possible way to overcome this is to utilize nanotechnology. Therefore, research detailing other types of nanocarriers that have the potential to be incorporated into 3D printed scaffolds for localized adjuvant therapy is presented.

Identifying Modifiable and Non-modifiable Risk Factors of Readmission and Short-Term Mortality in Osteosarcoma: A National Cancer Database Study.

There are limited data to inform risk of readmission and short-term mortality in musculoskeletal oncology. The goal of this study was to identify factors independently associated with 30-day readmission and 90-day mortality following surgical resection of osteosarcoma. We retrospectively reviewed patients (n = 5293) following surgical resection of primary osteosarcoma in the National Cancer Database (2004-2015). Univariate and multivariate methods were used to correlate variables with readmission and short-term mortality. Of 210 readmissions (3.97%), risk factors independently associated with unplanned 30-day readmission included comorbidity burden (odds ratio [OR] 2.4, p = 0.042), Medicare insurance (OR 1.9, p = 0.021), and axial skeleton location (OR 1.5, p = 0.029). A total of 91 patients died within 90 days of their surgery (1.84%). Risk factors independently associated with mortality included age (hazard ratio 1.1, p < 0.001), increasing comorbidity burden (OR 6.6, p = 0.001), higher grade (OR 1.7, p = 0.007), increasing tumor size (OR 2.2, p = 0.03), metastatic disease at presentation (OR 8.5, p < 0.001), and amputation (OR 2.0, p = 0.04). Chemotherapy was associated with a decreased risk of short-term mortality (p < 0.001). Several trends were clear: insurance status, tumor location and comorbidity burden were independently associated with readmission rates, while age, amputation, grade, tumor size, metastatic disease, and comorbidity burden were independently associated with short-term mortality.

Reconstruction with a Custom made Prosthetic Wrist Arthrodesis after Bone Tumor Resections of the Distal Radius. Single Centre Experience.

Objective The present study aimed at analyzing the clinical, radiological and functional results of the reconstruction of the distal radius after tumor resection with a custom-made metal arthrodesis implant and compare them with other types of distal radius reconstruction, as presented in the literature. To our best knowledge, this is the first article describing this particular type of implant and patient functionality. Methods Functional outcomes of reconstruction of the distal radius were assessed in a series of 4 patients. Three of the patients having had resection of giant cell tumors (GCTs), one patient having had resection of osteosarcoma. Results There were no major implant-related complications like infection, nonunion or loosening. Two patients had to undergo further surgery for protruding metalwork. Overall function was good according to the Musculoskeletal Tumor Society MSTS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Conclusion The present study shows that custom-made metal arthrodesis implant benefits from the fact that it can be used as a salvage option when other treatments have failed, or it can be used as a primary option in cases in which there is limited bone stock after distal radius tumor resection.