Many factors influence bone metastases of lung cancer, and several studies report about survival of skeletal metastasis. However, few studies have focused on identifying the prognostic factors for skeletal metastasis of lung cancer, especially following orthopedic surgery. We conducted a retrospective analysis of the clinical characteristics of skeletal metastasis from lung cancer and discuss the prognostic factors. We performed a medical record review of 202 patients who were diagnosed with skeletal metastasis from lung cancer. Adenocarcinoma was found in 116 patients (57.4%), squamous cell carcinoma in 29 (14.4%), small-cell lung cancer (SCLC) in 37 (18.7%), and large-cell carcinoma and other types of cancer in 20 patients (9.9%). Orthopedic surgery for skeletal metastasis was performed in 41 patients (20.3%). Lung cancer survival was 12.1 months. After diagnosis of lung cancer, skeletal metastasis was found at a mean of 2.5 months, and skeletal metastasis survival was 9.8 months. Lung cancer survival in patients younger than 60 years was 13.8 months, and lung cancer survival in patients 60 years or older was 10.8 months (p = 0.009). Skeletal metastasis survival in patients younger than 60 years was 11.0 months, and skeletal metastasis survival in patients 60 years or older was 8.8 months (p = 0.002). Mean skeletal metastasis survival with surgery was 12.6 months and without surgery was 9.1 months (p < 0.000). In the multivariate analysis of lung cancer survival, age under 60 years [HR (95% CI) 1.549 (1.122–2.139), p = 0.008], non-small cell lung cancer pathology type [HR (95% CI) 1.711 (1.157–2.532), p = 0.008], chemotherapy for skeletal metastasis [HR (95% CI) 8.064 (3.981–16.332), p < 0.000], and radiation therapy for skeletal metastasis [HR (95% CI) 1.791 (1.170–2.742), p = 0.007] were significant, independent, good prognostic factors. In the multivariate analysis of skeletal metastasis survival, age under 60 years [HR (95% CI) 1.549 (1.124–2.134), p = 0.007], non-small cell lung cancer pathology type [HR (95% CI) 2.045 (1.373–3.047), p < 0.000], chemotherapy for skeletal metastasis [HR (95% CI) 7.121 (3.542–14.317), p < 0.000], and orthopedic surgical treatment for skeletal metastasis [HR (95% CI) 1.710 (1.148–2.547), p = 0.008] were significant, independent, good prognostic factors. Patients who survived longer were less than 60 years old, received chemotherapy as treatment for skeletal metastasis, had NSCLC rather than SCLC, and underwent orthopedic surgery for skeletal metastasis.

Song M, et al. Clin Orthop Surg. 2024 Oct;16(5):820-826. https://doi.org/10.4055/cios22017

Purpose: The current study aimed to report the perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures. Methods: We analyzed 48 consecutive operations in 45 patients who were treated with internal fixation using the modified Stoppa approach between March 2016 and July 2018. This included three revision operations. The mean age of the patients was 54.5 years, and the patients included 35 male patients and 10 female patients. All fractures occurred as a consequence of high-energy trauma and 70.3% had associated injuries at the time of the fracture. The mean Injury Severity Score was 9.03 +/- 5.60. The perioperative complications found during and immediately after surgery were recorded and were classified into three categories: vascular injuries, nerve injuries, and other complications. Results: Overall, 14 perioperative complications (29.2%) in 14 cases were identified. The most common complications were nerve injuries, which occurred in seven cases, all involving the obturator nerve. Uncontrollable vascular injuries occurred in six cases, which required additional incisions and support of vascular surgeons or postoperative interventions. Additionally, one case of peritoneal tearing occurred, which required help from an abdominal surgeon. Conclusions: While the modified Stoppa approach seems to be a viable method to treat pelvic fractures, significant perioperative complications may occur, suggesting that surgeons should pay careful attention to minimize the damage to other structures and that appropriate support from other surgical departments is paramount.

Artemisia fukudo Makino belongs to the Asteraceae family, is a halophyte that can grow in salinity soils and is known for its various physiological activities. However, few studies were comparing it according to the growth environment. Therefore, in this study, we analyzed the antioxidant activity, functional ingredients, and safety of Artemisia fukudo Makino according to the growth environment. Total polyphenol content was the highest in native mature leaves, but 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) and 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity was higher in cultivated leaves than in native leaves. The total mineral content, excluding sodium, was higher in cultivated than in native leaves. The content of potassium and calcium was higher in cultivated leaves than in native leaves. In addition, heavy metal analysis showed that cultivated leaves were generally lower than those of native leaves. Residual pesticides were not detected in all samples. In conclusion, since there is no significant difference in cultivated leaves compared to native leaves, it was judged that cultivated leaves could be used as a variety to be grown and mass-produced.

Limb Length Discrepancy (LLD) is a common condition that can result in gait abnormalities, pain, and an increased risk of early degenerative osteoarthritis in the lower extremities. Epidemiological studies indicate that mild LLD, defined as a discrepancy of 10 mm or less, affects approximately 60–90% of the population. While more severe cases are less frequent, they are associated with secondary conditions such as low back pain, scoliosis, and osteoarthritis of the hip or knee. LLD not only impacts daily activities, but may also lead to long-term complications, making early detection and precise measurement essential. Current LLD measurement methods include physical examination and imaging techniques, with physical exams being simple and non-invasive but prone to operator-dependent errors. To address these limitations and reduce measurement errors, we have developed an AI-based automated lower-limb length measurement system. This method employs semantic segmentation to accurately identify the positions of the femur and tibia and extracts key anatomical landmarks, achieving a margin of error within 4 mm. By automating the measurement process, this system reduces the time and effort required for manual measurements, enabling clinicians to focus more on treatment and improving the overall quality of care.

Rationale: Follicular dendritic cell sarcoma (FDCS) is an intermediate-grade malignancy originating from follicular dendritic cells. Nodal FDCS is the most common type, meaning that the extranodal type may not be recognized and could be easily misdiagnosed. Reported extranodal sites include the head and neck, retroperitoneum, spleen, liver, and gastrointestinal tract. FDCS in the soft tissue is extremely rare. Patient concerns: A 75-year-old male presented with complaints of a localized swelling and intra-muscular soft tissue mass in the left upper thigh. Diagnosis: The present tumor consisted of fascicular or vague storiform-arranged spindle cells with less pleomorphism and many lymphoid aggregates. Tumor cells were positive for CD21, CD35, CD68, vimentin, and EGFR. Intra-muscular FDCS was confirmed by immunohistochemical studies. Interventions: The patient received a wide marginal excision, followed by adjuvant radiotherapy. Outcomes: Symptomatic improvements were achieved and no subsequent relapses were observed. Lessons: If the tumor arises in the extranodal sites, especially in the soft tissue, it is difficult to include FDCS in the differential diagnosis. When the immunoprofile is not consistent with that of common spindle cell tumors, immunostaining for follicular dendritic cell markers such as CD21, CD23, and CD35, as well as further immunohistochemistry for D2-40, CD68, EGFR, Epstein-Barr virus, and BRAF can be helpful for the diagnosis and subtyping of FDCS. To the best of our knowledge, the present case is the first case of intramuscular FDCS.