Osteosarcoma is recognized as the most prevalent primary bone malignancy, primarily affecting children and adolescents. It is characterized by its aggressive behavior and high metastatic potential, which often leads to poor patient outcomes. Despite advancements in surgical techniques and chemotherapy regimens, the prognosis for patients with osteosarcoma remains unsatisfactory, with survival rates plateauing over the past few decades. A significant barrier to effective treatment is the development of chemotherapy resistance, which complicates the management of the disease and contributes to high rates of recurrence. This review article aims to provide a comprehensive overview of recent advancements in osteosarcoma therapy, particularly in overcoming chemotherapy resistance. We begin by discussing the current standard treatment modalities, including surgical resection and conventional chemotherapy agents such as methotrexate, doxorubicin, and cisplatin. While these approaches have been foundational in managing osteosarcoma, they are often limited by adverse effects and variability in efficacy among patients. To address these challenges, we explore novel pharmacological strategies that aim to enhance treatment outcomes. This includes targeted therapies focusing on specific molecular alterations in osteosarcoma cells and immunotherapeutic approaches designed to harness the body’s immune system against tumors. Additionally, we review innovative drug delivery systems that aim to improve the bioavailability and efficacy of existing treatments while minimizing toxicity. The review also assesses the mechanisms underlying chemotherapy resistance, such as drug efflux mechanisms, altered metabolism, and enhanced DNA repair pathways. By synthesizing current research findings, we aim to highlight the potential of new therapeutic agents and strategies for overcoming these resistance mechanisms. Ultimately, this article seeks to inform future research directions and clinical practices, underscoring the need for continued innovation in treating osteosarcoma to improve patient outcomes and survival rates.

The phenomenon of bone metastases presents a significant challenge within the context of advanced cancer treatments, particularly pertaining to breast, prostate, and lung cancers. These metastatic occurrences stem from the dissemination of cancerous cells into the bone, thereby interrupting the equilibrium between osteoblasts and osteoclasts. Such disruption results in skeletal complications, adversely affecting patient morbidity and quality of life. This review discusses the intricate interplay between cancer cells and the bone microenvironment, positing the bone not merely as a passive recipient of metastatic cells but as an active contributor to cancer progression through its distinctive biochemical and cellular makeup. A thorough examination of bone structure and the dynamics of bone remodeling is undertaken, elucidating how metastatic cancer cells exploit these processes. This review explores the genetic and molecular pathways that underpin the onset and development of bone metastases. Particular emphasis is placed on the roles of cytokines and growth factors in facilitating osteoclastogenesis and influencing osteoblast activity. Additionally, this paper offers a meticulous critique of current diagnostic methodologies, ranging from conventional radiography to advanced molecular imaging techniques, and discusses the implications of a nuanced understanding of bone metastasis biology for therapeutic intervention. This includes the development of targeted therapies and strategies for managing bone pain and other skeletal-related events. Moreover, this review underscores the imperative of ongoing research efforts aimed at identifying novel therapeutic targets and refining management approaches for bone metastases. It advocates for a multidisciplinary strategy that integrates advancements in medical oncology and radiology with insights derived from molecular biology and genetics, to enhance prognostic outcomes and the quality of life for patients afflicted by this debilitating condition. In summary, bone metastases constitute a complex issue that demands a comprehensive and informed approach to treatment. This article contributes to the ongoing discourse by consolidating existing knowledge and identifying avenues for future investigation, with the overarching objective of ameliorating patient care in the domain of oncology.

Background: Many governments worldwide have established guidelines regarding children’s physical activity and sedentary behaviors linked to positive health outcomes. While research has established low adherence to these guideline levels, it is unclear whether parents’ knowledge, perceptions, and support around these behaviors might be barriers to adherence. Aims: This study examines parents’ knowledge and agreement with guideline levels of physical activity, screen time, and sleep time, as well as their support for these behaviors. Methods: Parents of 5–12-year-old children who presented to a regional general practitioner (GP) office in New South Wales (NSW) responded to a survey regarding their child’s physical activity, screen, and sleep time, as well as what they believed to be guideline levels, their perceived ideal levels, and the levels of support they provide for each of these behaviors. Results: Parents’ perceived ideal levels for their child’s physical activity and screen time were more ambitious than government levels and were consistent with sleep time guidelines. There were, however, few associations between parent support levels and children’s actual or perceived ideal levels of these behaviors. Discussion: The findings suggest that parents’ perceptions of ideal levels of physical activity and sedentary behavior may not hinder adherence to government guidelines. However, inconsistent, or ineffective support strategies can constrain adherence and thus be a viable intervention target.

Introduction: Various factors including the system of examination affect students’ academic achievement. Annual or semester-based examinations are commonly observed practices. Students like semester system, as their academic performance is significantly higher in this system. Medical education in Pakistan has largely followed the British system of preclinical and clinical years of teaching followed by end-of-year examinations. In the wake of medical education reform, the semester system of examination having objective assessment was recently introduced in medical institutes of Pakistan. There is no empirical evidence regarding the effects of this change on medical students’ academic achievement. This study aimed to assess whether the semester system has made any difference in the academic performance of medical students as compared to the annual system of examination. Method: Anatomy percentage scores of two batches of students who sequentially took annual and semester examinations were collected from a medical university. The data were analyzed for normality and later descriptive and inferential statistical tests were carried. Results: The data of 748 students (semester = 319 and annual = 429) were entered for analysis. The students who took semester-based examination (N = 319, M = 72.30, SD = 8.25) performed better than the students who took annual examination (N = 429, M = 64.36, SD = 10.69). The difference in mean percentage scores was statistically significant (t-test = 11.04, degrees of freedom (df) = 746; p < 0.01; 95% CI, 6.53-9.35). Discussion: The results demonstrated the enhanced scores of students who sat the semester examination. The findings of this research supported the earlier studies that suggested the restructuring of course durations and examination system have enhanced students’ achievement. Also, the objective assessments method showed improved academic performance. Conclusion: The study found that anatomy knowledge assessment scores of students who sat semester examination were significantly higher than students who sat the end-of-year examination. Further studies are needed to understand if this difference is also observed in other basic sciences subjects and continues in the performance clinical years.

Medical education faces increasing demand for scalable grading solutions. Large language models have been proposed as automated graders for high-stakes assessments, but evidence for their reliability in multimodal practical examinations remains limited. This retrospective inter-rater reliability study compared three LLMs: ChatGPT-4o, Gemini 2.5 Flash, and Claude 3.5 Haiku with original human reference scores on 19 integrated anatomy, histology, and physiology objective structured practical examination items completed by 309 pre-medical students. Human reference scores were assigned during live summative grading by two content experts who divided items, with each item marked by one expert across all students; no human inter-rater reliability estimate was available. Items required simultaneous image interpretation and short-answer responses. Models were evaluated using zero-shot prompting reflecting deployment-realistic conditions. Agreement was assessed using Spearman's ρ, Cohen's κ, intraclass correlation coefficients, and Bland-Altman analysis. Item-level gap analysis compared student success rates with LLM performance across items. Rank-order correlations were strong across all models (ρ = 0.784-0.921), but categorical agreement diverged substantially. Pass/fail agreement ranged from 52.1% (ChatGPT; κ = 0.067, slight) to 84.1% (Claude; κ = 0.680, substantial). Bland-Altman analysis showed inconsistent systematic bias: Claude over-scored by +2.5 points, Gemini under-scored by -5.0 points, and ChatGPT by -10.0 points. Item-level gap analysis highlighted three recurring divergence patterns: non-standard histological staining, three-dimensional spatial reasoning from two-dimensional images, and semantic inflexibility in short-answer evaluation. The most extreme case was a pelvic three-dimensional model item on which 93.3% of students succeeded by human grading but all three LLMs assigned a mean score of zero. Strong rank-order correlation alone does not support LLM grading for categorical decisions in high-stakes assessment contexts. LLMs may serve as assessment assistants for first-pass ranking and discrepancy flagging, but item-level human review of flagged discordances, error-profile monitoring, and preserved human authority over pass/fail decisions are required before high-stakes deployment.

Peer-assisted learning enhances conceptual understanding in anatomy education; however, its impact on structured cognitive outcomes remains unclear. We evaluated the effect of the Peer-Assisted Uniform Learning (PAUL) program on musculoskeletal (MSK) anatomy objective structured practical examination (OSPE) performance. We used a cross-sectional, controlled, observational design to analyse the OSPE scores of 304 students. Seventy-nine students who attended at least two PAUL sessions formed the exposure group, while 225 served as the control group. The PAUL participants alternated between tutor and tutee roles during the sessions. The OSPE items were divided into Cluster 1 (identification/recall) and Cluster 2 (application/analysis). A validated survey was used to assess the participants perceived learning outcomes and satisfaction. PAUL participants outperformed non-participants in Cluster 1 (78.4 vs. 73.7, p = 0.01) and Cluster 2 (87.2 vs. 82.8, p = 0.02). The relative gain was greater for application-based items (interaction effect: F = 8.37, p = 0.004), supporting the program's effect on higher-order reasoning. Survey responses (91 % response rate) showed high satisfaction (mean 4.3 ± 0.6) and perceived learning gains (mean 4.1 ± 0.7); 85 % of students reported improved understanding of the subject. The PAUL program, grounded in social constructivist principles and supported by faculty oversight, improved performance in both recall and application of MSK anatomy OSPE items, with the strongest impact on application-based learning.