Single Bone Research Articles

A Study On The Pattern And Distribution of Skull Fractures In Fatal Road Traffic Accidents

Introduction: Road traffic accidents (RTA's) are a leading cause of mortality and a serious injury world wide, with skull fractures frequently emerging as a significant consequence of such incidents. The pattern and distribution of skull fractures can provide valuable insights into the mechanisms of injury and the severity of accidents. Understanding these patterns is crucila for improving both preventive measures and clinical responses. Materials and methods:This is aretrospective cross-sectional study of one year duration.All the cases of road traffic accident deaths with skull fractires were included in the study. A total of 342 cases of death due to fatal RTA were present and 140 cases had skull fractures. Results: The commonest site of fracture was the vault, observed in 64.28% of the cases. In fractures involving single bone of vault, frontal bone fractures were seen in the highest number of cases, in 29 cases(32.22%). The MCF was the most commonly involved area in the base of the skull fractures, observed in 7.14% of the cases. Conclusion: A substantial amount of financial burden is produced on the family of the deceased, on the health care system and as well as on the economic output of the country. Therefore, measures should be sought to reduce the RTA's as a number of positive and correct interventions can bring down their number.

Advancing bone biomaterial design: exploring outer microtopography and multi-BSTM membrane production from a single bone source

Advancing bone biomaterial design: exploring outer microtopography and multi-BSTM membrane production from a single bone source

Navigating the Diagnostic Maze: A Case Report of Uncommon Cardiac Metastasis in Childhood Ewing Sarcoma

AbstractEwing sarcoma is a bone cancer affecting children and young adult males. It usually presents as a single bone tumor, but it can also occur in multiple locations. Nevertheless, Ewing sarcoma is an extremely aggressive tumor capable of metastasizing to other parts of the body, such as the lungs, bones, liver, and lymph nodes. Cardiac metastases are rare, indicating a poor prognosis, as they suggest that the cancer has become more advanced and challenging to treat.This case report describes a 9-year-old boy who presented with complaints of fever and multiple swellings in the calvaria, periorbital region, clavicle, and left thigh. Laboratory investigations revealed a high erythrocyte sedimentation rate, elevated absolute neutrophil count, high phosphate and calcium levels, and low magnesium levels. Computed tomography imaging revealed the presence of multifocal osseous expansile lytic lesions, multiple pulmonary metastases, and extensive soft tissue involvement of the heart. Based on these findings, possible differential diagnoses of Langerhans cell histiocytosis, lymphoma, and Ewing sarcoma were considered. Further histopathological examination and immunohistochemistry confirmed a final diagnosis of metastatic Ewing sarcoma.The most common metastasis sites for Ewing sarcoma are the lungs, with rare occurrences in the central nervous system, and metastasis to the heart is uncommon. We present here a rare undiagnosed Ewing sarcoma with cardiac metastasis, in addition to pulmonary and multifocal osseous metastasis. This case is unique because multifocal osseous involvement is rare and further lung and heart involvement is even rarer in Ewing sarcoma.

Clinical outcomes of arthroscopic suture fixation combined with loop plate vs. posterior approach open reduction and cannulated screw fixation for treating tibial avulsion fractures of the posterior cruciate ligament: a retrospective study.

Comparison of the efficacy of arthroscopic suture fixation combined with loop plate vs. the posterior approach involving open reduction and intramedullary nail fixation in treating posterior cruciate ligament tibial avulsion fractures (PCLTAFs). A retrospective analysis was conducted on the clinical data of patients diagnosed with PCLTAF who were admitted to Northern Jiangsu People's Hospital between June 2019 and March 2022. Based on distinct surgical procedures, the patients were categorized into two groups: arthroscopic group (33 cases), involving a single bone tunnel, high-strength suture, loop plate, and anchor screw fixed under arthroscopy, and open reduction and internal fixation (ORIF) group (13 cases), involving a modified posterior medial approach and fixation using 1-2 cannulated screws. Key parameters, including surgical duration, postoperative fracture alignment, fracture-healing duration, range of motion changes, postoperative Lysholm scores, and VAS scores were documented and compared between the two groups. The study cohort comprised 46 patients, with 28 males and 18 females, and the median age was 29 years old (range: 15-69). There were no significant differences in the baseline characteristics, including knee Lysholm scores, between the two groups. The arthroscopic group exhibited significant improvement in all eight Lysholm score indicators (all P < 0.001). The total Lysholm score also exhibited significant improvement before and after surgery in both groups (P < 0.001). Following surgery, the arthroscopic group demonstrated improvements in all indicators, but had a slightly longer operating time compared to the ORIF group. No significant differences were observed in the Lysholm scores for the knee joint between the two patient groups before and after surgery (P > 0.05). Arthroscopic suture fixation in conjunction with looped plate binding can significantly improve knee function and clinical effect for patients in the treatment of PCLTAF, promotingearly postoperative functional recovery of patients.

Subsidence of the Corail stem in total hip arthroplasty: no influence of bony contact

IntroductionThis study investigated stem subsidence following primary total hip arthroplasty (THA) with a Corail stem in patients who underwent two-staged bilateral THA. The second outcome of interest was to investigate whether a specific single cortical bone contact point might reduce postoperative stem subsidence.MethodsThe present study was conducted following the STROBE guidelines. The records of patients who underwent THA between 2016 and 2023 were accessed. All patients who underwent two-staged bilateral THA were retrieved. The direct contact between the stem and the cortical bone was assessed at various points in the metaphysis and the distal portion of the stem (diaphysis) in both anteroposterior radiographs of the pelvis (medial and lateral bone contact) and a Lauenstein view of the hip (anterior and posterior bone contact). The following parameters were measured and compared to assess stem subsidence: distance from the proximal femur at the stem bone interface and the tip of the lesser trochanter (distance A); distance from the tip of the lesser trochanter and the tip of the femoral stem (distance B).ResultsIn total, 250 patients were included, 45% (149 of 250 patients) were women and 61% (153 of 250 THAs) were implanted primarily on the right side. The mean age of patients at the time of the first THA was 64.3 ± 10.0 years and the mean body mass index (BMI) was 28.0 ± 4.9 kg/m2. The mean length of the follow-up was 14.1 ± 10.8 months. The overall stem subsidence following THA was 2.8 ± 0.7 mm (P < 0.006). A direct cortical bone-implant contact did not exert a statistically significant difference in subsidence of the THA stem at the metaphysis and diaphysis (P > 0.5). Stem subsidence following THA with a collarless cementless Corail stem was approximately 2.8 mm at 14 months.ConclusionsDirect cortical bone contact of the stem at diaphysis and metaphysis seems not to influence stem subsidence following THA using the Corail stem.

Nonunion of Vascularized Fibula With Shortening and Multiplanar Deformity in a 6 Years Old Managed Simultaneously With Hexapod Circular External Fixator

The hexapod circular external fixator is considered a major upgrade to the classic Ilizarov ring fixators, which made it easier to manage complex deformities. Surgeons now, using it, can manage deformities in all three planes simultaneously without the need for frame modifications. We present a case report that shows the versatile nature of the hexapod circular fixator in a 6-year-old female patient who presented with multiple problems seen in a single bone, namely, two types nonunion at two different sites of a vascularized fibula graft of the leg (hypertrophic nonunion at the proximal site and atrophic nonunion at the distal site) with varus, procurvatum, and internal rotation deformities as well as 3-cm shortening. She underwent vascularized fibular graft surgery to treat osteomyelitis of the tibia 2 years prior. A hexapod circular fixator was applied which would statically stabilize the lower nonunion site (augmented with bone marrow injection at that site) and corrected the deformities and shortening through distraction at the proximal hypertrophic nonunion site in one surgical procedure. The case demonstrates the versatility of the hexapod circular fixator in treating complex orthopaedic situations, maintaining a minimally invasive approach while allowing full weight-bearing.

DNMT3A CHIP-driver mutations ignite the bone marrow

Abstract Background Clonal hematopoiesis of indeterminate potential (CHIP) is an acquired, genetic cardiovascular (CV) risk factor affecting about 10% of the general population at the age of 70 years. Most CHIP-driver mutations affect the epigenetic regulator gene DNMT3A. Experimental studies suggest a causal link between CHIP and inflammation-driven atherosclerosis, but the underlying mechanisms of how few mutant clones provoke adverse clinical outcomes in patients remain obscure. Methods Single monocytes and bone marrow cells from DNMT3A-mutation carriers undergoing coronary angiography and open-heart surgery underwent RNA and genomic DNA sequencing in parallel on a single cell level. This approach enabled us to compare mutant and non-mutant cells directly within carriers, and to non-carrier cells. Atherosclerotic chimeric mice reconstituted with a mixture of Dnmt3a-deficient (CD45.2) and -competent (CD45.1) bone marrow served as an experimental model to compare mutant to non-mutant macrophages in atherosclerotic lesions. Results Surprisingly, RNA/gDNA parallel sequencing revealed that gene expression profiles of mutant monocytes resembled those of non-mutant monocytes in carriers of DNMT3A-CHIP mutations (n=4). Collectively, however, monocytes of DNMT3A mutation carriers were more inflammatory than those of matched non-carrier patients. Mutant hematopoietic stem and progenitor cells, analyzed by RNA/gDNA parallel sequencing in two carriers, expressed more activation and inflammatory markers compared to non-mutant cells within the same bone marrow, and intraindividual differences declined as cells differentiated into monocytes. Macrophages were isolated from atherosclerotic aortas of mixed bone marrow chimeric mice based on CD45.1 (non-mutant) or CD45.2 (mutant or non-mutant controls) expression and subjected to single cell RNA sequencing. Inflammation markers were higher expressed in non-mutant macrophages within carrier mice than in non-mutant macrophages of non-carrier chimeras, and showed relatively small differences compared to Dnmt3a-deficient macrophages. Conclusions Our experimental findings in humans and mice support a pathomechanistic model in which few DNMT3A-CHIP mutation-carrying hematopoietic stem cells stimulate non-mutant cells within the bone marrow, thereby augmenting inflammation downstream in all circulating monocytes and their progeny in atherosclerotic lesions.

TMEM175 plays a crucial role in osteoblast differentiation by regulating lysosomal function and autophagy

Bone provides structural support, enables movement, protects internal organs, regulates calcium and phosphorus levels, and contains bone marrow essential for hematopoiesis. Osteoblasts are specialized cells responsible for bone formation through the secretion of extracellular matrix components. Transmembrane protein 175 (TMEM175), which functions as an endosomal/lysosomal K+ channel and a lysosomal H+ channel, regulates lysosomal function and autophagy. Despite the recognized importance of lysosomes and autophagy in osteoblast differentiation, the specific role of TMEM175 in osteoblast differentiation has not been revealed. In this study, we investigated whether TMEM175 is associated with human bone mineral densityand fracture and examined the role of TMEM175 in osteoblast differentiation. In analyses of single nucleotide polymorphismsof pore ion channel genes using the mouse2human database, a significant correlation between TMEM175 single nucleotide polymorphisms and human bone mineral density and fracture was identified. TMEM175 expression levels were found to increase during osteoblast differentiation from bone chip-derived mesenchymal stem cells (BMSCs). Knockdown of TMEM175 in BMSCs suppressed osteoblast differentiation, as evidenced by decreased matrix mineralization and lower expression levels of osteoblast marker genes. Further analysis indicated that TMEM175 deficiency leads to lysosomal dysfunction and partially impairs autophagic clearance during osteoblast differentiation. Moreover, the TMEM175 inhibitor 4-aminopyridinedecreased osteoblast differentiation of BMSCs. Taken together, this study reveals that TMEM175 plays an important role in osteoblast differentiation by regulating lysosomal function and autophagic clearance.

Differences in the Shape of the Frontal Bone between 20th-Century Euro-Americans and Germans

Geometric morphometrics is a very useful but rarely applied concept in forensic anthropology. It uses information on the shape of an object for data analysis. For this study, geometric morphometrics has been used to compare the shape of the frontal bone between a German and a Euro-American sample (both early 20th century). Results were compared using size-only, shape-only and size-and-shape combined. Results show that the frontal shapes of the two study populations can clearly be distinguished from one another. The best classification results could be achieved when combining size and shape data for analysis. Centroid size showed significant variation by group and sex, and that Euro-Americans are more sex dimorphic than Germans. We conclude that shape data provides a considerable amount of extra information for population affinity estimation, even on a single cranial bone like the frontal. A broader application of geometric morphometrics in forensic anthropology could thus help generating a more reliable biological profile, as well as providing additional insight into German-American morphometric differentiation.

Comparative Histological Analysis of Dentine-Derived Tooth Grafts in Maxillary vs Mandibular Socket Preservation: A Retrospective Study of 178 Cases.

(1) Background: In recent years, there has been a growing interest in tooth-derived materials as valuable alternatives to synthetic biomaterials for preventing alveolar ridge dimensional changes. This study aimed to evaluate the histological and clinical differences between alveolar ridge preservation procedures in the maxilla and mandible using demineralized dentin treated with Tooth Transformer®. (2) Methods: A total of 178 patients in good general health were enrolled, with 187 post-extractive sockets lacking buccal and/or palatal bone walls. Alveolar socket preservation procedures and histological evaluations were performed. The sites were divided into two groups: Group A (99 mandibular samples) and Group B (108 maxillary samples). After 5 months (±1 month), single bone biopsies were performed for histologic and histomorphometric analysis. (3) Results: Clinical outcomes demonstrated a good healing of hard and soft tissues with an effective maintenance of bone architecture in both groups. Histomorphometric analysis revealed a total bone volume of 50.33% (±14.86) in Group A compared to 43.53% (±12.73) in Group B. The vital new bone volume was 40.59% (±19.90) in Group A versus 29.70% (±17.68) in Group B, with residual graft dentin material volume at 7.95% (±9.85) in Group A compared to 6.75% (±9.62) in Group B. (4) Conclusions: These results indicate that tooth-derived material supports hard tissue reconstruction by following the structure of the surrounding bone tissue. A 6.8% difference observed between the maxilla and mandible reflects the inherent disparities in natural bone structures in these regions. This suggests that the bone regeneration process after tooth extraction adheres to an anatomical functional pattern that reflects the specific bone characteristics of each area, thus contributing to the preservation of the morphology and functionality of the surrounding bone tissue.

Open segmental tibial bone defects treated with Ilizarov frame: a radiological and functional outcome study with average ten year follow-up.

Surgical reconstruction of large post-traumatic tibial bone and soft tissue defects following high-energy trauma presents a significant challenge for orthopaedic surgeons. This study aimed to evaluate the functional and radiological outcomes of large post-traumatic tibial bone and soft tissue defects managed by single or double-level bone transport using the Ilizarov technique. 13 patients who underwent treatment for large tibial bone defects (Gustillo IIIa, IIIb, IIIc) along with soft tissue defects with Ilizarov from 2010 to 2020A.D were included. ASAMI functional and radiological outcomes were assessed at the final follow-up to report the outcome. The mean age was 27.38 (18-48). An average bone defect was 7.69cm (5-13cm). Based upon the Gustillo-Anderson classification (GA), 2 (15%) of them were GA - 3A, 7 (54%) were GA - 3B, and 4 (31%) were GA - 3C. The average time of distraction was 11.76 weeks (8-16). The average time for the union was 37 weeks (27-48 weeks). The average bone lengthening was 7.69cm (5-13cm). The mean final leg length discrepancy (LLD) at the final follow-up was 1.96cm (0-4cm). The primary union was achieved in eight cases, and five required bone grafting at the docking site. Using the ASAMI (Association for the Study of the Method of Ilizarov) scoring system, the functional results were excellent in six and good in seven cases, while the bony results were excellent in eight, good in four and fair in one case. Good to excellent functional and radiological scores (ASAMI) can be expected when using the Ilizarov frame for simultaneous treatment of the large tibial bone and soft tissue defect when this method is applied with correct principles.

Comparing the prognosis of esophageal adenocarcinoma with bone and liver metastases: A competing risk analysis.

About half of the patients with esophageal cancer are presenting with metastasis at initial diagnosis. However, few studies have concerned on the prognostic factors of metastatic esophageal adenocarcinoma (mEAC). This research aimed to investigate the effects of single bone metastasis (BM) and single liver metastasis (LM) on prognosis of mEAC patients. Data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database. We compared the effects of LM and BM on overall survival (OS), EAC-specific survival (CSS), and EAC-specific death (EASD) by multivariate Cox regression, Kaplan-Meier analysis, and competing risk regression models. A total of 1,278 EAC patients were recruited in this study. Of which 78.95% (1009/1278) were EASD, and 12.68% (162/1278) were non-EAC-specific death (non-EASD). In multivariate Cox regression analysis, surgery, chemotherapy, and AJCC.T2 (vs. T1) were identified as protective factors for OS&CSS, while divorced/separated, single/unmarried (vs. married), grade III-IV (vs. grade I-II) and BM (vs. LM) were identified as risk factors. Competing risk regression analysis further confirmed that surgery and chemotherapy were beneficial to the patients with mEAC, and BM (vs. LM) was a risk factor for mEAC patients when considering the existence of the competitive risk events. Our study indicated that mEAC patients with BM face a worse prognosis compared to those with LM. Additionally, surgery and chemotherapy emerge as protective factors for mEAC patients. These findings offer evidence-based insights for clinical management and contribute to the field.

Nano-scale modeling of energy dissipation in a single lamella reveals the significant contribution of collagen-mineral sliding to intrinsic bone toughness

Although collagen-mineral sliding is recognized as one of the intrinsic mechanisms that contribute to the bone toughness, its precise role in energy release at the nano-scale, as well as its relationship to other intrinsic toughness mechanisms, remains unclear. This lack of understanding stems from the challenges associated with quantifying the specific nature of contact at the mineral-collagen interface, and the energy dissipation capacity resulting from plastic deformation at this scale. To address this issue, we developed a three-dimensional model of mineralized collagen fibril using ABAQUS, incorporating hyperelastic isotropic collagen, elastic isotropic mineral, and a cohesive contact formulation to represent the collagen-mineral interface. Knowing the properties of collagen and mineral and using a parametric modeling approach, we estimated the properties of contact based on experimental measurements of the stress-strain behavior in a single bone lamella, considering the angle of the collagen fibril in relation to the loading axis. By comparing the experimental elastic modulus with the model predictions, we determined that the cohesive contact exhibited a maximum strength of 9 MPa and a fracture energy of 50 mJ/m2 within the bone. Further analysis indicated that fracture energy at the collagen-mineral interface is potentially closer to 5 mJ/m2. Using these findings, we concluded that the interfaces were responsible for 52% to 98% of the energy release in mineralized collagen fibrils, depending on collagen angle, both directly and indirectly by influencing stress and strain in adjacent collagen fibril. The results of this study demonstrated that plastic deformation at the collagen-mineral interface is the primary mechanism underlying bone toughness at the nano-scale. Importantly, we found that these conclusions held true regardless of the angle of the collagen fibril relative to the loading axis. The modeling framework presented in this study provides a valuable tool for investigating the elastic and post-yield behavior of bone across different mineral volume fractions at the nano-scale, and at the lamellar level.

Fibrous Dysplasia: Clinicopathological Behavior and Its Management

Fibrous dysplasia (FD) is a rare disorder of bone in which normal bone is replaced by abnormal fibro-osseous tissue. It more commonly involves the long bones, craniofacial bones, ribs, and pelvis. The involvement of single bone is called as monostotic type of FD and if multiple bones are involved it is called polyostotic type of FD. Its occurrence is predominantly observed in teenagers, and it usually becomes static after adulthood. The incidence of monostotic FD (MFD) is four times more than that of polyostotic FD (PFD). The posterior region of the jaw bone is more prone and rarely crosses the midline. The malignant potential is 0.5% for cases that remain untreated. Here, we present a case of MFD involving the posterior region of the right side of the mandible in a 37-year-old female patient. The clinical diagnostic approach, different imaging modalities, and histological examination methods for definitive diagnosis have been elaborated. During the regular follow-up, the MFD lesion showed no obvious signs of progression or malignancy features.

Crestal Sinus Lift with the Hydrodynamic Technique: Prospective Clinical Study at 3 Years Follow-Up

Aim: This study aimed to evaluate the implant survival rate, marginal bone loss (MBL), and surgical complications in single dental implants placed in the atrophic posterior maxilla using a transcrestal sinus lift with injectable graft materials. Materials and Methods: A prospective longitudinal study was conducted at IRCCS San Raffaele, Milan, Italy. Fifty-four patients with single edentulous sites and residual bone heights &lt; 5 mm were included. A transcrestal sinus lift was performed using non-cutting drills (Cosci’s technique) and xenogenic bone graft in gel form (Gel40, Tecnoss, Italy). Follow-up visits were at 1 week, 3 and 6 months, and annually for 3 years. Results: The implant survival rate was 98.04%, with one implant lost. MBL values were 0.71 ± 0.94 mm at 6 months, 1.00 ± 0.99 mm at 1 year, 1.03 ± 1.00 mm at 2 years, and 1.02 ± 1.01 mm at 3 years. Our ANOVA showed a significant MBL increase from 6 months to 1 year (p = 0.015), with no significant changes thereafter. Minimal surgical complications were observed, each occurring in 1.85% of cases. Conclusion: Transcrestal sinus lifts with injectable graft materials demonstrate high implant survival, acceptable MBL, and minimal complications, making it a reliable option for posterior maxilla rehabilitation.

Early Neolithic avifaunal remains from southeast Anatolia provide insight into Early Holocene species distributions and long‐term shifts in their range

Based on the species‐rich avifaunas from Early Neolithic sites across Upper Mesopotamia (southeast Türkiye, northern Syria, northern Iraq), we compared seven species' Early Holocene distribution patterns with that of their modern species ranges. The avifaunal remains from four sites were analysed by the authors and bird identifications from 10 additional sites were extracted from published reports. In the case of the Common Crane Grus grus, Grey Partridge Perdix perdix and Black Francolin Francolinus francolinus, shifts in distributions relate to significant changes in climate marking the transition from the Pleistocene to the Holocene. In contrast, the massive decline of the Griffon Vulture Gyps fulvus represents a more recent phenomenon related to anthropogenic impact on their habitats and food sources. For the Black‐bellied Sandgrouse Pterocles orientalis and the Pin‐tailed Sandgrouse P. alchata, changes in distributional range from the Early Holocene to the present could not be detected. Finally, a single bone of Macqueen's Bustard Chlamydotis macqueenii at Göbekli Tepe is unexpected and conceivably we are dealing with the remains of a rare vagrant, more likely to be found in dry steppe and desert habitats, which were located south of the study area at that time. This study highlights the value of archaeozoological finds in helping to understand how species distributional ranges have changed over time. Similarly, our work suggests that authors studying archaeozoological data should not assume that present‐day distributional ranges of taxa of interest represent the ranges of these species in the past.

Bone of contention: Intra-element variability in remodelling of human femora based on histomorphometric and isotope analyses.

The volume of human carbon (δ13C) and nitrogen (δ15N) isotope data produced in archaeological research has increased markedly in recent years. However, knowledge of bone remodelling, its impact on isotope variation, and the temporal resolution of isotope data remains poorly understood. Varied remodelling rates mean different elements (e.g., femur and rib) produce different temporal signals but little research has examined intra-element variability. This study investigates human bone remodelling using osteon population density and the relationship with carbon and nitrogen isotope data at a high resolution, focusing on variation through femoral cross-sections, from periosteal to endosteal surfaces. Results demonstrate considerable differences in isotope values between cross-sectional segments of a single fragment, by up to 1.3‰ for carbon and 1.8‰ for nitrogen, illustrating the need for standardised sampling strategies. Remodelling also varies between bone sections, occurring predominantly within the endosteal portion, followed by the midcortical and periosteal. Therefore, the endosteal portion likely reflects a shorter period of life closer to the time of death, consistent with expectations. By contrast, the periosteal surface provides a longer average, though there were exceptions to this. Results revealed a weak negative correlation between osteon population density and δ15N or δ13C, confirming that remodelling has an effect on isotope values but is not the principal driver. However, a consistent elevation of δ15N and δ13C (0.5‰ average) was found between the endosteal and periosteal regions, which requires further investigation. These findings suggest that, with further research, there is potential for single bone fragments to reconstruct in-life dietary change and mobility, thus reducing destructive sampling.

Pediatric skeletal injuries in emergency department; an alarm of child maltreatment in Egypt: A cross-sectional study

BackgroundChild physical abuse, a type of child maltreatment (CM), poses a significant global public health concern. Nonaccidental fractures and soft tissue injuries, which encompass any action that directly or indirectly harms a child, are the primary indicators of physical abuse in children. ObjectiveThis study aimed to investigate the prevalence, risk factors, and outcomes of accidental and nonaccidental skeletal fractures in a sample of Egyptian children. MethodsA cross-sectional analytical study was conducted between March 2022 and August 2022. A total of 156 children who presented with skeletal injuries and attended Mobarak Central Hospital were enrolled. Patients were subjected to full history taking, complete examination, and investigations. A structured questionnaire was administered to all the legal guardians. ResultsPhysical abuse was reported in 22.4 % of cases, while medical neglect was reported in 19.9 % of cases. The incidence of physical abuse was notably higher among children whose fathers were smokers and/or drug addicts (p ≤ 0.05). The most common form of physical abuse was hitting (94.3 %). Among skeletal injuries, fractures were predominant (94.3 %), primarily closed fractures associated with contusions. Fractures of the upper limb accounted for the highest incidence (94.3 %) of skeletal injuries, and 60 % of physically abused children experienced moderate-severity injuries. ConclusionThe most common fracture observed in abused children is the upper limb fracture, typically involving a single bone. Clinicians should be more vigilant in suspecting abuse, even in cases where there is an isolated fracture, and advocate for the development of parental training programs.

SITE AND RATE OF OSSICULAR CHAIN EROSION IN PATIENTS UNDERWENT TYMPANOMASTOID SURGERY

Background: Chronic suppurative otitis media (CSOM) is a common problem affecting middle ear and it’s commonly presented with chronic ear discharge and decreased hearing. Hearing problem in CSOM is primarily caused perforated tympanic membrane and in some cases by the presence of erosion of the ossicular chain. The study aimed to show the rate and site of ossicular chain erosion in patients with chronic suppurative otitis media underwent tympanomastoid surgery. Patient and methods: a cross sectional study conducted on 87 patients performed tympanomastoid surgery for chronic middle ear infection where their ossicular status has been assessed intraoperatively. Results: our study shows that 40% of the operated ears has at least a single bone erosion and the Incus bone was the most affected ossicle while the Malleus was the least one 54% and 14% respectively. No statistically significant difference was seen between bone erosion and gender as well as the side of operation. Conclusion: ossicular erosion is a common problem affecting patient with chronic suppurative otitis media and the surgeons should be aware about this pathology and they should have the proper skill to correct such problem.

Liquid Biopsies as Non-Invasive Tools for Mutation Profiling in Multiple Myeloma: Application Potential, Challenges, and Opportunities.

Over the last decades, the survival of multiple myeloma (MM) patients has considerably improved. However, despite the availability of new treatments, most patients still relapse and become therapy-resistant at some point in the disease evolution. The mutation profile has an impact on MM patients' outcome, while typically evolving over time. Because of the patchy bone marrow (BM) infiltration pattern, the analysis of a single bone marrow sample can lead to an underestimation of the known genetic heterogeneity in MM. As a result, interest is shifting towards blood-derived liquid biopsies, which allow for a more comprehensive and non-invasive genetic interrogation without the discomfort of repeated BM aspirations. In this review, we compare the application potential for mutation profiling in MM of circulating-tumor-cell-derived DNA, cell-free DNA and extracellular-vesicle-derived DNA, while also addressing the challenges associated with their use.