Search Results (73)

Proton pump inhibitors (PPIs) are widely prescribed medications primarily used to treat gastroesophageal reflux disease, peptic ulcer disease, and upper gastrointestinal bleeding. Despite clear therapeutic benefits in appropriate contexts, widespread overprescribing and extended use without clear indications have prompted significant concerns about associated risks. Accumulating evidence, predominantly from observational studies, suggests that long-term PPI use may lead to complications such as vitamin and mineral deficiencies, increased risks of infections, dysbiosis, renal dysfunction, bone fractures, cardiovascular disease, and certain malignancies. This narrative review not only synthesizes the current evidence surrounding PPI-related harms and existing deprescribing guidelines but also offers a novel perspective on how stewardship principles can be applied to promote responsible PPI prescribing. In particular, we propose a stewardship-oriented deprescribing framework rooted in implementation science, focusing on provider behavior, patient engagement, and health system-level integration. Recognizing these potential harms, evidence-based deprescribing strategies such as tapering, intermittent dosing, and transitions to alternative therapies are critical to mitigate unnecessary patient exposure. Effective implementation of deprescribing requires addressing patient, provider, and institutional barriers through educational initiatives, policy support, and structured monitoring. By promoting judicious PPI prescribing and proactive stewardship practices, clinicians can significantly reduce medication-related harm and improve patient safety. Full article

Background: Patellar resection is recommended in cases of massive cortical bone disruption or malignancies. Modern literature lacks a consensus surgical reconstruction after total patellectomy. Our study reviews the surgical techniques described in the literature and summarizes the reported functional outcomes and complication rates. Materials: We systematically reviewed the existing literature, searching the PubMed, Embase, and Scopus databases for articles published between 1950 and 2024. We recorded age, diagnosis, tumor size, Lodwick classification, soft tissue involvement, and pre-operative fractures for each case or case series. We also recorded the reconstructive approaches. Complications, local recurrences, MSTS scores, and knee range of motion (ROM) were considered when reported. Results: Twenty-eight articles met our inclusion criteria. Among these, 4 were case series and 24 were case reports. A total of 47 cases treated with total patellectomy were reviewed. Reconstruction was performed with direct suture in 8 cases, while 17 had local augments, including allograft (10 cases), muscle flaps or transportations (4), autologous bone (1), or a composite (2). Reconstruction was not mentioned in 22 cases. ROM was reported for 17 cases, and the MSTS score was reported for 9 cases. Conclusions: In cases of relatively small tissue defects, a direct suture of the extensor apparatus can allow adequate functional recovery. In cases of larger gaps, surgeons should use muscle flaps, transfers, or soft tissue augments. Massive bone and tendon allografts should mainly be considered in cases where the neoplasm was not confined to the patella but extensively involved the patellar ligament or the quadriceps tendon. Full article

Orthopedic implant technology has historically seen difficulties in attaining long-term stability and biological integration, leading to complications such as implant loosening, wear debris production, and heightened infection risk. Nanotechnology provides a revolutionary method for addressing these constraints through the introduction of materials characterized by exceptional biocompatibility, durability, and integration potential. Nanomaterials (NMs), characterized by distinctive surface topographies and elevated surface area-to-volume ratios, facilitate improved osseointegration and provide regulated medication release, thereby creating a localized therapeutic milieu surrounding the implant site. To overcome the long-standing constraints of conventional implants, such as poor osseointegration, low mechanical fixation, immunological rejection, and implant-related infections, nanotechnology is causing a revolution in the field of orthopedic research. NMs are ideally suited for orthopedic applications due to their exceptional features, including increased tribology, wear resistance, prolonged drug administration, and excellent tissue regeneration. Because of their nanoscale size, they can imitate the hierarchical structure of real bone, which in turn encourages the proliferation of cells, lowers the risk of infection, and helps with the mending of bone fractures. This article will investigate the wide-ranging possibilities of nanostructured ceramics, polymers, metals, and carbon materials in bone tissue engineering, diagnostics, and the treatment of implant-related infections, bone malignancies, and bone healing. In addition, this paper will provide a basic overview of the most recent discoveries in nanotechnology driving the future of translational orthopedic research. It will also highlight safety evaluations and regulatory requirements for orthopedic devices. Full article

Background: AI has been adopted in dentistry for diagnosis, decision making, and therapy prognosis prediction. This systematic review aimed to identify AI models in dentistry, assess their performance, identify their shortcomings, and discuss their potential for adoption and integration in dental practice in the future. Methodology: The sources of the papers were the following electronic databases: PubMed, Scopus, and Cochrane Library. A total of 20 out of 947 needed further studies, and this was encompassed in the present meta-analysis. It identified diagnostic accuracy, predictive performance, and potential biases. Results: AI models demonstrated an overall diagnostic accuracy of 82%, primarily leveraging artificial neural networks (ANNs) and convolutional neural networks (CNNs). These models have significantly improved the diagnostic precision for dental caries compared with traditional methods. Moreover, they have shown potential in detecting and managing conditions such as bone loss, malignant lesions, vertical root fractures, apical lesions, salivary gland disorders, and maxillofacial cysts, as well as in performing orthodontic assessments. However, the integration of AI systems into dentistry poses challenges, including potential data biases, cost implications, technical requirements, and ethical concerns such as patient data security and informed consent. AI models may also underperform when faced with limited or skewed datasets, thus underscoring the importance of robust training and validation procedures. Conclusions: AI has the potential to revolutionize dentistry by significantly improving diagnostic accuracy and treatment planning. However, before integrating this tool into clinical practice, a critical assessment of its advantages, disadvantages, and utility or ethical issues must be established. Future studies should aim to eradicate existing barriers and enhance the model’s ease of understanding and challenges regarding expense and data protection, to ensure the effective utilization of AI in dental healthcare. Full article

Background/Objectives: Pathological fractures of the mandible are uncommon and often result from underlying conditions such as osteoradionecrosis, malignancies, or medication-related osteonecrosis of the jaw (MRONJ). Their management is challenging due to compromised bone quality and complex patient comorbidities. This study presents a 15-year experience from a tertiary oral and maxillofacial surgery center, highlighting the clinical characteristics, etiologies, treatment approaches, and outcomes of these fractures. Methods: A retrospective review was conducted on patients diagnosed with pathological mandibular fractures between 2010 and 2024. Data collected included demographics, fracture etiology and location, diagnostic imaging, treatment modality, complications, and long-term outcomes. Results: Fifty patients met the inclusion criteria. The mean age was 66.4 years, with a predominance of male patients (78%). The most common etiology was osteoradionecrosis (48%), followed by primary malignancy (22%) and MRONJ (16%). In 82% of cases, surgical management was required, most frequently involving marginal or segmental mandibular resection (gnathectomy), with or without immediate reconstruction. Conservative treatment was reserved for select cases with high surgical risk. Complications occurred in 54% of patients, including persistent fistulas, pathological communication with the skin or oral cavity, and the need for revision surgery. Long-term follow-up revealed variable survival, with many patients experiencing reduced quality of life due to complex postoperative courses. Conclusions: Pathological fractures of the mandible present significant diagnostic and therapeutic challenges, particularly in patients with osteoradionecrosis or malignancies. Early diagnosis and individualized, multidisciplinary treatment planning are essential. This study underscores the need for a standardized classification system and treatment algorithm to guide management and improve outcomes in this complex patient population. Full article

Background/Objectives: Multiple myeloma is a malignancy of plasma cells detected in the bone marrow, inducing symptoms like anemia, hypercalcemia, renal problems, and bone fractures in multiple myeloma patients, affecting their quality of life. The bone marrow microenvironment plays a crucial role in the prognosis and progression of the disease. The purpose of this study was to examine the relationship between the percentages of the major cell populations of the bone marrow, including immune cells, and physical function/quality of life in multiple myeloma patients after first-line treatment. Methods: Twenty-one multiple myeloma patients (N = 14 men, N = 7 women) participated in the study after completing first-line treatment. Bone marrow and blood samples were taken one hundred days after transplantation, while physical function (6 min walking test, handgrip test, maximal aerobic power, and isometric strength), health-related quality of life (QLQ-C30), and body composition (DXA) were assessed 2–5 days later. Flow cytometry was used to assess the percentages of plasma cells, mast cells, B cells (total, precursors, naïve, and memory), T cells (total, CD27− and CD27+), NK/NKT cells (total, CD27− and CD27+), eosinophils, monocytes, neutrophils, myeloid progenitors, erythroblasts, and erythroid progenitors, expressed as percentages of total nucleated cells of the bone marrow. Results: The percentage of CD27+ NK/NKT cells was correlated with five parameters of the quality of life questionnaire: physical function (r = 0.78, p = 0.005), role functioning (r = 0.69, p = 0.020), fatigue (r = −0.86, p = 0.000), pain (r = 0.68, p = 0.021), and dyspnea (r = −0.80, p = 0.003). Conclusions: In conclusion, stronger immune surveillance in the bone marrow from CD27+ NK/NKT cells is correlated with better quality of life in multiple myeloma patients. Full article

Pseudomyogenic haemangioendotheliomas (PMH) are exceedingly rare, mostly occurring in soft tissue, with malignant cases even more uncommon. In this report, we present a case of a 28-year-old male initially suspected of having a fibroblastic osteosarcoma of the right femur, which was then correctly diagnosed as a primary pseudomyogenic hemangioendothelioma of the bone with synchronous metastases to other skeletal segments. Molecular analysis through targeted RNA sequencing confirmed the correct diagnosis, revealing a fusion transcript ACTB::FOSB. To our knowledge, this is one of the few reported cases of suffering from multiple pathological fractures. The rapid skeletal progression and the onset of distant metastases in this case is highly unusual considering the typically indolent clinical course commonly reported in the literature for this tumor. Full article

Background: Acquired hemophilia A (AHA) is a rare, life-threatening autoimmune disorder characterized by inhibitory autoantibodies against factor VIII (FVIII), resulting in spontaneous or trauma-related bleeding. This study reviews a single-center cohort to evaluate patient characteristics, treatments, and outcomes. Methods: We retrospectively reviewed the records of 22 adult patients diagnosed with AHA between 2012 and 2024. The data included demographics, clinical presentation, laboratory findings, treatments, and outcomes. Statistical analysis compared genders and evaluated treatment strategies and remission outcomes. Results: The cohort had an equal gender distribution with an average age of 62 years (22–102 years). Suspected etiologies included pregnancy (27%), malignancy (23%), autoimmune diseases (5%), and idiopathic causes (45%). The most common presentation was spontaneous cutaneous hematoma (82%). Severe bleeding necessitating hemostatic therapy occurred in 9% of cases. Initial immunosuppressive therapy (IST) with corticosteroids achieved remission in 45% of patients, while additional treatment with Rituximab or Cyclophosphamide was required in others. Emicizumab, a novel FVIII-mimetic, was successfully used in one patient with severe refractory bleeding. Remission was achieved in 64% of patients within a median of 3 months, with a recurrence rate of 14%. No thrombotic events were observed, although corticosteroid side effects, including one hip fracture, were noted. Conclusions: IST remains the cornerstone of AHA treatment, though side effects necessitate individualized care. Emicizumab shows promise, particularly in refractory cases and fragile populations. Future research is needed to evaluate long-term outcomes and spontaneous remission rates, especially in special populations like post-partum women and the elderly. Full article

Multiple myeloma is an incurable hematologic malignancy arising from plasma cells. The uncontrolled growth of monoclonal plasma cells leads to an abnormal overproduction of immunoglobulins. The recommended course of treatment for MM is according to disease progression and responses to therapeutic intervention, highlighting the necessity for multiple treatment options that alleviate different parts of MM. This comprehensive review provides insights into the current treatments and how to take preventative and prognostic measures. In advanced MM, osteoporosis is a common symptom that originates from a lack of regulation in osteoclast activity and bone resorption. Bisphosphonates such as zoledronic acid and pamidronate along with monoclonal antibodies such as denosumab hinder osteoclast function and aid in reducing the risk of fractures in patients with advanced MM. For targeted therapy approaches, proteasome inhibitors impede protein degradation pathways that cause an accumulation of misfolded proteins promoting cancer cell proliferation in patients with MM. CAR-T is another targeted therapy that can utilize T cells to target and isolate MM cells. Overall, this review highlights the frontrunners of treatments for those diagnosed with MM. Full article

Background/Objectives: Osteoporotic fractures, particularly subcapital hip fractures (SCF), pose a significant healthcare and economic burden. The routine pathological examination of resected femoral heads in such cases is common practice, aimed at identifying malignancies that may have contributed to bone fragility. This study evaluated the cost-effectiveness and clinical utility of routine femoral head pathology in patients undergoing surgical treatment for SCF. Methods: A retrospective cohort study was conducted at a university-affiliated, tertiary care hospital. Patients undergoing surgical treatment for SCF between 2015 and 2018, with available femoral head pathology reports, were included. Data on demographics, prior or active malignancies, surgical procedures, and pathology results were analyzed. Results: The study included 230 patients with a mean age of 82.4 ± 14.1 years, of whom 57% were female. A total of 72 (31%) patients had a history of malignancy at the time of surgery. Pathological examination identified malignancies in eight patients (3.4%), all of whom had active malignancies at the time of admission. The most common malignancies detected were breast cancer and multiple myeloma (three cases each). None of the findings led to changes in patient management. Conclusions: The routine pathological examination of femoral heads following SCF provided a limited diagnostic yield and did not alter clinical management in this cohort. These findings suggest that routine pathology may not be cost-effective and support the adoption of selective screening approaches based on clinical risk factors such as a history of malignancy or atypical fracture presentations. Full article

The rapid growth of unconventional natural gas development (UNGD), also known as hydraulic fracturing, has raised concerns of potential exposures to hazardous chemicals. Few studies have examined the risk of childhood cancer from exposure to UNGD. A case–control study included 498 children diagnosed with leukemia, lymphoma, central nervous system neoplasms, and malignant bone tumors during the period 2010–2019 identified through the Pennsylvania Cancer Registry. Cases were matched to controls using Pennsylvania birth records. For each subject, a new overall UNGD exposure metric was calculated which incorporates both spatial (proximity) and temporal (duration) aspects of well activity. Conditional logistic regression models were used to estimate the risk of combined and individual cancers by overall UNGD exposure, and well proximity. Children with a higher overall UNGD exposure (3rd/4th quartiles) had an increased risk for the four malignancies combined [OR] 1.69 (95% CI 1.01, 2.82) and 1.79 (95% CI 1.00, 3.19) compared to non-exposed children. Overall, individuals living within 0.5 miles of a UNGD site were 3.94 times (95% CI 1.66, 9.30) more likely to develop a malignancy compared to non-exposed children and the risk of lymphoma within 0.5 miles and 0.5–1 miles was also elevated [ORs of 5.05 (95% CI 1.09, 23.39) and 7.71 (95% CI 1.01, 59.00), respectively] compared to non-exposed. Our study found that overall UNGD cumulative activity as well as a proximity to UNGD wells were associated with an increased risk of childhood lymphoma and overall childhood cancers combined. Full article

With technological advancements, remarkable progress has been made with the convergence of health sciences and Artificial Intelligence (AI). Modern health systems are proposed to ease patient diagnostics. However, the challenge is to provide AI-based precautions to patients and doctors for more accurate risk assessment. The proposed healthcare system aims to integrate patients, doctors, laboratories, pharmacies, and administrative personnel use cases and their primary functions onto a single platform. The proposed framework can also process microscopic images, CT scans, X-rays, and MRI to classify malignancy and give doctors a set of AI precautions for patient risk assessment. The proposed framework incorporates various DCNN models for identifying different forms of tumors and fractures in the human body i.e., brain, bones, lungs, kidneys, and skin, and generating precautions with the help of the Fined-Tuned Large Language Model (LLM) i.e., Generative Pretrained Transformer 4 (GPT-4). With enough training data, DCNN can learn highly representative, data-driven, hierarchical image features. The GPT-4 model is selected for generating precautions due to its explanation, reasoning, memory, and accuracy on prior medical assessments and research studies. Classification models are evaluated by classification report (i.e., Recall, Precision, F1 Score, Support, Accuracy, and Macro and Weighted Average) and confusion matrix and have shown robust performance compared to the conventional schemes. Full article

Background and Clinical Significance: Femoral neck fracture frequently occurs in the elderly population but may also present in patients diagnosed with primary cancer or bone metastases. A pathological, oligosymptomatic fracture associated with epithelioid haemangioendothelioma (EHE), a rare endothelial cell-derived sarcoma, is uncommon. Case Presentation: A 44-year-old patient underwent biopsy procedures three times (2010, 2012, 2013) for a focal lesion of the left ischium, none confirming its malignant nature. The last biopsy revealed a neoplastic tissue with features of discrete dysplasia. The lesion did not undergo medical follow-up for seven consecutive years. In August 2020, the patient presented with right lower limb pain. A CT scan, PET/CT scan, and biopsy confirmed EHE with spindle/sarcomatous features. In November 2020, chemotherapy (5xADIC) started (PET/CT confirmed a partial response). After its completion in July 2021, bone progression occurred and sirolimus-based therapy was started. After 3 months, a small liver metastasis was visualized on PET/CT, which did not result in the termination of treatment. In December 2021, pamidronate-based antiresorptive therapy was started. Liver metastasis remained stable in follow-up CT scans. Due to pelvic and spinal lesions, the patient was assisted by elbow crutches and underwent radiotherapy, remaining professionally active. The patient did not report any trauma, but in August 2023, a subsequent CT scan revealed a subcapital fracture of the left femoral neck in the fusion phase. Due to pelvic changes and the stable nature of the fracture, surgical treatment was abandoned. Conclusions: An oligosymptomatic femoral neck fracture, not requiring medical intervention is considered a rare complication of bone cancer. Full article

Background: Vertebral augmentation (VA) procedures are used to treat painful vertebral fractures caused by malignancies, but there are few data on the radiation exposure for patients and proceduralists during these VA procedures. We retrospectively examined the radiation dose exposure during VA procedures and defined the characteristics of patients who underwent such procedures. Methods: We conducted a retrospective observational cohort study including patients with cancer who experienced axial back pain from compression fractures caused by malignancies. Participants were identified using an electronic medical records database and must have had evidence of stable vertebral compression fractures upon imaging and documentation of a clinical evaluation. We collected data on patient demographics, fluoroscopy time (FT) and dose (FD) during the procedure, the volume of polymethylmethacrylate injected, and reported complications. Results: Overall, 140 patients were included. Their median age was 69, and they were mostly men (n = 79). The most common diagnosis was multiple myeloma (41.4%). Most patients had a single-level compression fracture of the thoracolumbar spine. The mean FT was 233.80 s, with higher FTs for patients with an elevated body mass index and patients younger than 60 years. The average FD was 157.98 mGy, with higher FDs for patients with an elevated BMI and for male patients. Pain relief was not associated with FT or FD. Conclusions: Patients with cancer who underwent VA experienced longer FT and higher FD compared to their non-cancer counterparts in the literature. However, we found multiple confounders for this relationship. Full article

Bone metastasis and steroids are known to activate the coagulation system and induce osteoporosis, pathological bone fractures, and bone pain. Heparanase is a protein known to enhance the hemostatic system and to promote angiogenesis, metastasis, and inflammation. The objective of the present study was to evaluate the effects of steroids and malignancy on the coagulation factors and osteoblast activity in the bone tissue. The effects of dexacort and malignant medium were evaluated in osteoblasts derived from human bone marrow mesenchymal stem cells and human umbilical vein endothelial cells (HUVECs). The bones of mice treated with dexacort for 1 month were studied. Bone biopsies of ten patients with bone metastasis, ten with steroid-induced avascular necrosis (AVN), and ten with osteoarthritis were compared to ten controls. We found that dexacort and malignant medium significantly increased the heparanase levels in osteoblasts and HUVECs and decreased the levels of alkaline phosphatase (ALKP). Peptide 16AC, derived from heparanase, which interacts with tissue factor (TF), further increased the effect, while peptide 6, which inhibits interactions between heparanase and TF, reversed the effect in these cells. The bone microcirculation of mice treated with dexacort exhibited significantly higher levels of heparanase, TF, TF pathway inhibitor (TFPI), TFPI-2, thrombin, and syndecan-1, but reduced levels of osteocalcin and ALKP. The pathological human bone biopsies’ microcirculation exhibited significantly dilated blood vessels and higher levels of heparanase, TF, TFPI, TFPI-2, and fibrin. In summary, steroids and malignancy increased the activation of the coagulation system in the bone microcirculation and reduced the osteoblast activity. Heparanase inhibitors should be further investigated to attenuate bone fractures and pain. Full article