Postmenopausal osteoporosis (PMOP), resulting from estrogen deficiency and excessive bone resorption, leads to increased bone fragility and fractures. Current treatments are hindered by suboptimal targeting and short drug half-lives. This study introduces a bone-targeted nanoparticle system, GLG1@NPs-VEGF/BMP2, which incorporates vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP2) plasmids, and is modified with Golgi complex-localized glycoprotein-1 (GLG1) to enhance bone-specific delivery. PLGA nanoparticles (NPs) were loaded with VEGF/BMP2 plasmids and functionalized with GLG1. In vitro, particle characterization, osteogenic differentiation of MC3T3-E1 cells, and angiogenic effects on HUVECs were evaluated. In vivo, ovariectomized (OVX) rats were used to assess bone targeting, therapeutic efficacy, and biosafety. The GLG1@NPs-VEGF/BMP2 complex exhibited sustained release and high plasmid loading efficiency. In vitro, it effectively upregulated VEGF/BMP2 expression, promoted osteogenic differentiation in MC3T3-E1 cells, and enhanced HUVEC proliferation, migration, and tube formation. In vivo, GLG1-mediated targeting increased nanoparticle accumulation in bone. OVX rats treated with GLG1@NPs-VEGF/BMP2 demonstrated improved trabecular microstructure, increased bone strength, and higher VEGF/BMP2/CD31 expression, with no evidence of systemic toxicity. This approach, exploiting GLG1's bone-targeting capability, enhances VEGF/BMP2 delivery, restoring bone formation and angiogenesis in PMOP. GLG1@NPs-VEGF/BMP2 represents a promising strategy for precision therapy in osteoporosis.
Diabetes mellitus impairs bone metabolism through chronic hyperglycemia, oxidative stress, and inflammation, leading to reduced osteoblast activity and downregulation of key pluripotency genes such as Octamer-binding transcription factor 4 (OCT4), Nanog homeobox (NANOG), SRY-box transcription factor 2 (SOX2), and Reduced expression protein 1 (REX1).The present study investigated whether the timing of aerobic exercise (morning vs. evening) influences the expression of pluripotency genes in the bone tissue of diabetic mice. Eighteen male NMRI mice were assigned to healthy control, diabetic control, or diabetic exercise groups. Diabetes was induced using a high-fat diet combined with low-dose streptozotocin. Aerobic training was performed for eight weeks at either ZT3 (morning) or ZT15 (evening), five sessions per week, at 50-60% Vmax. Blood glucose, insulin, HOMA-IR, and maximum running speed were assessed, and gene expression in bone tissue was measured using qRT-PCR. Data were analyzed using one-way ANOVA with Tukey post hoc testing (p < 0.05). Diabetic mice exhibited significant increases in glucose, insulin, and HOMA-IR, along with marked reductions in pluripotency gene expression, particularly at ZT3. Aerobic exercise significantly improved metabolic parameters and partially restored gene expression, with the greatest enhancement observed at ZT15. SOX2 and REX1 showed the most robust recovery under evening training conditions. The findings indicate that circadian timing modulates the beneficial effects of aerobic exercise on pluripotency gene expression in diabetic bone tissue. Evening exercise (ZT15) exerts superior restorative effects, suggesting that chronobiology aligned training may serve as an effective strategy for improving bone regenerative potential in diabetes.
Primary malignant bone tumors are rare, biologically heterogeneous malignancies that require highly specialized, multidisciplinary treatment. Surgical excision of the primary tumor is considered a prerequisite for long-term survival in most affected patients. An association between hospital volume and outcome has been demonstrated for numerous oncological procedures but has been investigated less extensively in the context of bone sarcomas. The surgical expertise concentrated at high-volume centers (HVC) appears to translate directly into superior oncologic outcomes and a better prognosis. Key contributing factors include significantly lower rates of positive surgical margins and significantly reduced perioperative mortality. Furthermore, specialized surgical expertise enables limb-sparing procedures even in most complex cases. The definition of HVC has been inconsistent so far. Furthermore, centralized treatment in HVC requires the establishment of clear referral pathways and optimal cooperation between specialized centers and the wider healthcare system. The surgical treatment of primary malignant bone tumors should be centralized in specialized, high-volume sarcoma centers. In this context, hospital volume should also be understood as a proxy for specialized multidisciplinary expertise, adherence to clinical practice guidelines, and systematic quality improvement, which are all essential factors for the optimal treatment of bone sarcomas. Further studies are necessary to better define the term HVC in different healthcare systems and settings. HINTERGRUND: Primäre maligne Knochentumoren sind seltene, biologisch heterogene Malignome, die eine hochspezialisierte, multidisziplinäre Behandlung erfordern. Die operative Behandlung des Primärtumors gilt als Voraussetzung für das Langzeitüberleben bei den meisten Betroffenen. Ein Zusammenhang zwischen Behandlungsvolumen und Ergebnis ist für zahlreiche onkologische Eingriffe belegt, für Knochensarkome jedoch weniger umfassend untersucht. Die Konzentration chirurgischer Expertise in High-Volume-Zentren (HVZ) korreliert direkt mit einer verbesserten onkologischen Ergebnisqualität und einer besseren Prognose. Wesentliche Aspekte, die dazu beitragen, sind die signifikant niedrigeren Raten positiver Resektionsränder und die signifikant niedrigere perioperative Mortalität. Darüber hinaus ermöglicht die spezialisierte chirurgische Expertise auch in komplexen Fällen meistens extremitätenerhaltende Operationen. High-Volume-Zentren sind bislang uneinheitlich definiert. Des Weiteren erfordert eine zentralisierte Behandlung in HVZ die Ausgestaltung von Zuweisungspfaden und die optimale Vernetzung zwischen Spezialzentren und der flächendeckenden Versorgung. Die operative Behandlung primärer maligner Knochentumoren sollte in spezialisierten HVZ für Sarkome konzentriert werden. Dabei ist das Klinikvolumen auch ein Surrogat für die spezialisierte multidisziplinäre Expertise, die Einhaltung klinischer Leitlinien sowie die systematische Qualitätsverbesserung, die für die optimale Behandlung von Knochensarkomen erforderlich sind. Weitere Studien sind notwendig, um den Begriff des HVZ in unterschiedlichen Gesundheitssystemen und Versorgungssettings besser zu definieren.
Prostate cancer (PCa) is one of the most prevalent malignancies in men and frequently progresses to bone metastasis. Understanding the interactions between PCa cells and the bone microenvironment, as well as their impact on therapeutic response, is therefore of critical clinical relevance. This study aimed to investigate the effects of the osteogenic microenvironment on prostate cancer cells by constructing three-dimensional (3D) bioprinted in vitro co-culture models, and to evaluate how the osteogenic niche influences tumor malignant phenotypes. This study employed extrusion-based 3D bioprinting (3DP) to construct in vitro co-culture models of the PCa osteogenic microenvironment. Two 3D-PCa models based on LNCaP and PC-3 cells were each co-cultured with osteogenically differentiated adipose-derived stem cells (ADSCs) to generate corresponding osteogenic niche models. Tumor phenotypes and drug responses were evaluated using functional assays, histological and immunofluorescence analyses, molecular profiling, and RNA sequencing. The 3D bioprinted constructs exhibited structural stability and high reproducibility, providing a 3D growth environment that mimics key aspects of the in vivo tumor niche. The 3D-PCa models showed enhanced drug resistance, invasive potential, and adaptation to androgen-deprivation. Meanwhile, ADSCs exhibited robust osteogenic differentiation within 3D scaffolds. Under co-culture conditions, 3D-PCa cells exhibited enhanced malignant-like phenotypes, including increased proliferation and reduced drug sensitivity. Multi-level analyses further indicated that these phenotypic changes were associated with coordinated activation of epithelial-mesenchymal transition (EMT)-, hypoxia-, and mitogen-activated protein kinase (MAPK)-related signaling programs, accompanied by alterations in drug transporter expression and cell cycle distribution. The 3D co-culture model provides a biomimetic platform for simulating the PCa bone-metastatic microenvironment. This system enables investigation of the effects of the osteogenic niche on tumor behavior and therapeutic responses, and may serve as a useful tool for preclinical drug screening and evaluation of combination treatment strategies for bone-metastatic prostate cancer.
This study aimed to evaluate the 7-year outcomes of proximal humeral chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and bone grafting in pediatric patients. A total of 17 patients diagnosed with proximal humeral chondroblastoma who underwent surgical treatment consisting of intralesional curettage, cavity electrocauterization, and bone grafting at our center between January 1, 2008, and January 1, 2018, were retrospectively enrolled. All patients received postoperative splint immobilization for four weeks and were followed up for a minimum of seven years. Tumor recurrence was evaluated based on clinical manifestations and radiographic X-ray examination. Clinical outcomes included functional performance assessed using the Musculoskeletal Tumor Society (MSTS) score and the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) scale, as well as postoperative complications. In total, 17 patients with proximal humeral chondroblastoma were enrolled in our study, including 10 males and 7 females, with a mean age of 10.9 ± 1.8 years old (range from 8 to 14 years). Among these 17 cases, there were 6 cases with lesions extending through the epiphyseal plate, and 11 cases with lesions located inside the epiphysis. During follow-up, 1 patient suffered reoperation due to tumor recurrence. Shortening of the affected upper limb occurred in 9 patients (52.9%), which was significantly associated with a young age(P = 0.012). The mean shortening was 1.2 ± 0.9 cm compared with the contralateral limb. The overall mean postoperative MSTS was 27.5 ± 1.4 points, with no significant difference between observed the limb shortening group (27.3 ± 1.4) and the non-shortening group (27.8 ± 1.4,P = 0.550). The overall Quick DASH score averaged 4.8 ± 3.9 (0-15.9), and no statistically significant difference was detected between the shortening group (5.3 ± 4.5) and the non-shortening group (4.3 ± 2.8; P = 0.452). Intralesional curettage, cavity electrocauterization and bone grafting is an optional treatment for children with proximal humeral chondroblastoma but still has a risk of recurrence. Shortening of the affected upper limb is a common complication, which is possibly associated with young age but has no impact on the final functional outcomes. Level IV, retrospective case series.
Osteoporosis is a systemic skeletal disorder characterized by reduced bone strength and increased fracture risk, posing a major public health challenge. Hip and vertebral fractures, which predominantly affect older postmenopausal women, lead to significant disability and reduced quality of life. Accelerated bone loss begins during the menopausal transition, and early fractures (eg, wrist) can signal underlying skeletal fragility. Although effective screening tools and evidence-based lifestyle and pharmacologic interventions can prevent fractures, osteoporosis remains underdiagnosed and undertreated. Women's health clinicians play a critical role in integrating bone health assessment, prevention, and management into routine care for perimenopausal and postmenopausal women.
Complex bone and joint infections (BJIs) represent a major public health challenge because of their severity, functional consequences, and the complexity of their management. In 2008, France established a nationwide network of Referral Centers for Complex Bone and Joint Infections (CRIOAc), a pioneering organization based on specialized multidisciplinary team (MDT) meetings and comprehensive national territorial coverage. We conducted a nationwide descriptive study of the CRIOAc network, assessing its activity and evolution since its establishment, including organizational changes, funding mechanisms, scientific output, and academic activities. Data were extracted from the national CRIOAc information system, which prospectively records all cases discussed during MDT meetings. A descriptive bibliometric analysis of publications citing the seminal CRIOAc article was also performed. The network expanded from 8 coordinating referral centers at its inception to 32 accredited centers in 2024, providing nationwide coverage. It is governed by a National Scientific Committee representing all specialties and geographic regions. Since its creation, 64,859 patients have been managed within the network. The annual number of MDT meetings increased from 698 in 2011 to 1,760 in 2024, while the number of surgical admissions for BJI increased from 6,148 to 11,340 over the same period. The proportion of cases classified as complex remained stable at approximately 60-65%. The CRIOAc network has contributed to the development of national and international clinical guidelines, the establishment of a national inter-university diploma, the conduct of multicenter research projects, and the implementation of innovative phage-related anti-infective therapies. Bibliometric analysis demonstrates the growing international dissemination of the CRIOAc model. Eighteen years after its establishment, the CRIOAc network represents a pioneering and sustainable national model for the multidisciplinary management of complex BJIs, whose core principles are now supported by the international literature. Its mission has expanded beyond specialized clinical care to encompass research, education, and the evaluation of innovative therapeutic strategies. Further integration into European collaborative networks could strengthen its contribution to improving the management of complex bone and joint infections. IV; Retrospective study.
Severe malnutrition in the presence of child maltreatment and other specified feeding or eating disorder (OSFED) can lead to significant effects on bones. We present a case of severe malnutrition from child maltreatment that developed into osteoporosis and persistent electrolyte abnormalities due to hungry bone syndrome (HBS). We describe a 15-year-old female with a history of medical neglect and severe malnutrition presenting to the hospital after removal from mother's home. The patient was admitted, refed, and monitored for refeeding syndrome. She had an elevated parathyroid hormone (PTH) level, vitamin D deficiency, and electrolyte derangements requiring daily management for weeks. Once obtained, a dual-energy X-ray absorptiometry (DXA) scan demonstrated a total-body-less-head (TBLH) Z score of -5.9. The learning goals of this case are for the readers to: ● Understand the pathophysiology and typical presentation of HBS. ● Understand the unique presentation of HBS in the context of malnutrition. ● Distinguish HBS from refeeding syndrome.
Bone metastases (BM) occur in approximately 30% of patients with metastatic renal cell carcinoma (mRCC) and are associated with poor survival and symptomatic skeletal events (SSEs). Radium-223, an alpha-emitting bone-seeking radioisotope, and cabozantinib, a tyrosine kinase inhibitor, have demonstrated activity in BM. RADICAL (Alliance A031801; ClinicalTrials.gov identifier: NCT04071223) evaluated cabozantinib ± radium-223 in mRCC with BM. This phase II trial enrolled patients with mRCC of any histology with ≥1 BM. Patients were randomly assigned 1:1 to cabozantinib ± radium-223, stratified by osteoclast-targeted therapy (OTT), prior therapy, opioid use, and International mRCC Database Consortium (IMDC) risk. The primary end point was SSE-free survival (SSE-FS). Secondary end points included safety, objective response rate (ORR), progression-free survival, and overall survival (OS). A target of 124 evaluable patients was planned, with a prespecified interim futility analysis at 50% of expected SSE-FS events; the trial would stop if the stratified hazard ratio (sHR) > 1.0. The prespecified interim futility analysis was conducted after 90 patients were enrolled and crossed the futility boundary, leading to closure at 98 patients. The final analysis included all 98 patients. Median age was 63 years, 82.7% had clear cell histology, and 79.6% were using an OTT. IMDC risk was favorable (18.4%), intermediate (67.3%), and poor (14.3%). Median follow-up was 13.1 months. Median SSE-FS for cabozantinib with radium-223 versus cabozantinib was 16.7 versus 17.6 months (sHR, 1.46 [90% CI, 0.86 to 2.51]). Median OS was 28.3 versus 19.7 months (sHR, 1.40 [95% CI, 0.70 to 2.79]). ORR was 19.4% versus 25.0% (P = .78). Grade ≥3 adverse events were similar across arms (69.6% v 75.5%). Radium-223 did not improve SSE-FS when added to cabozantinib. The combination demonstrated a manageable safety profile.
Primary bone diffuse large B-cell lymphoma (PB-DLBCL) is a rare extranodal lymphoma in which consolidative radiation therapy (RT) has demonstrated survival benefit, particularly in early-stage disease. Disparities in access to radiation oncology services have been documented across multiple malignancies. This study evaluated national patterns of RT utilization in PB-DLBCL and identified demographic and socioeconomic factors associated with RT receipt. Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with PB-DLBCL between 2000 and 2015. Patients with bone as the primary site and known Ann Arbor stage were included. RT utilization was compared using chi-square and Fisher's exact tests, and multivariable logistic regression identified factors independently associated with RT receipt in overall and stage-stratified analyses. Of 1454 patients meeting inclusion criteria, 824 (56.7%) received RT. On multivariable analysis, Hispanic ethnicity (aOR 0.64, 95% CI 0.46-0.90; p = 0.010) and lower household income (aOR 0.72, 95% CI 0.56-0.93; p = 0.013) were independently associated with decreased RT receipt. Patients aged 40-70 and 70 + years were more likely to receive RT than those under 40. In stage-stratified analyses, disparities by Hispanic ethnicity (aOR 0.58; p = 0.013) and lower income (aOR 0.55; p < 0.001) were most pronounced in early-stage disease and nonsignificant in advanced-stage disease. Significant socioeconomic and ethnic disparities exist in RT utilization among PB-DLBCL patients, particularly in early-stage disease where RT confers established benefit. These findings underscore the need for targeted interventions addressing structural barriers to guideline-concordant radiation therapy. III.
Bone sarcoma treatment employs wide surgical margins to ensure complete tumour excision, sometimes at the expense of patient quality of life. As precision technologies advance, quantitative data to inform the planned accuracy of surgical margins is increasingly important. This study assesses two novel computational methods (M2, M3) to support the co-registration of 2D histologic images within 3D radiological volumes. Replicated evaluation of an established method (M1) is also performed with new data. M2 suits concave bisected sections by assuming a different orientation during tissue bandsaw than M1. M3 handles freeform geometries by using a third measurement to constrain 2D histology images within 3D space without need for geometric bandsaw assumptions. Three computed distances across 38 canine specimen dissections from each method were compared with three corresponding physical measurements collected during laboratory processing. M1 produced a mean error of 0.12 (± 1.7) mm, M2 produced a mean error of 0.06 (± 1.9) mm, while M3 produced a mean error of 0.02 (± 1.5) mm. Mean errors for each method were of similar magnitude to 3D registration error reported in histology co-registration frameworks for other tissues. This study supports a simple low cost opportunity for use of digital histology images to support bone sarcoma radiology interpretation and treatment planning.
The journal retracts the article "The Autophagic Process Occurs in Human Bone Metastasis and Implicates Molecular Mechanisms Differently Affected by Rab5a in the Early and Late Stages" [...].
Since humans spend the majority of their time indoors, exposure to indoor dust is a primary route for air pollutant inhalation. Although growing evidence links indoor dust to respiratory impairments, the mechanisms underlying its association with lung damage and immune homeostasis remain poorly understood. In this study, indoor dust samples collected from an industrial city in Northern China (Taiyuan, Shanxi Province) were used to establish a mouse inhalation model at environmentally relevant concentrations. Non-invasive pulmonary function tests using the whole-body plethysmography (WBP) system and histopathological examinations revealed that indoor dust exposure induced significant impairments in lung function, characterized by a 33.34% increase in Penh and a 19.06% reduction in Rpef in the 25 mg/kg group, alongside airflow limitation (reduced ventilatory capacity) and airway obstruction (inflammatory narrowing of the respiratory tract). Exposure also caused alveolar structural damage, interstitial inflammatory infiltration, and pulmonary fibrosis. Transcriptomic profiling (RNA-seq), flow cytometric immunophenotyping, and qRT-PCR further demonstrated disruption of immune homeostasis in the bone marrow (BM). These results suggest a potential interorgan crosstalk between the lung and BM mediated by inflammatory signaling, in which the lung-derived inflammatory signals might alter the hematopoietic function of the BM, while the BM could mobilize immune cells to sustain pulmonary inflammatory responses, further contributing to lung function impairment. This interorgan crosslink offers a new clue for understanding the mechanisms underlying indoor dust-related lung injury through lung-BM immune communication and for identifying candidate intervention targets for environmental respiratory diseases.
Nodular fasciitis (NF) and aneurysmal bone cyst (ABC) are uncommon entities that can mimic malignant neoplasms and be challenging to diagnose. Molecularly, the majority of NF and ABC cases are characterized by USP6 rearrangements, which result in a promoter swap and aberrant upregulation of USP6 RNA. While fluorescence in situ hybridization (FISH) can be used to confirm USP6 rearrangement, it often requires multiple days to complete. Here, we examine if USP6 RNA chromogenic in situ hybridization (CISH) could aid in the diagnosis of NF and ABC. We found that USP6 RNA CISH was positive in 89% (16/18) of NF cases and 58% (7/12) of ABC cases. Importantly, in histologic mimics of NF and ABC, USP6 RNA CISH was negative. USP6 FISH or next-generation sequencing was performed on all NF and ABC cases, one consult case diagnosed as benign fibroblastic neoplasm with associated ossification, and a subset of histologic mimics to assess for USP6 rearrangements. Ninety-two percent (22/24) of cases with USP6 rearrangement also demonstrated positive USP6 RNA CISH staining, while 100% (19/19) of cases that were negative for USP6 rearrangement, including 2 NF, 4 ABC, and 13 histologic mimics, were also negative for USP6 RNA CISH. One case was inconclusive by FISH, but positive by CISH. Our results indicate that USP6 RNA CISH can serve as a useful tool in the diagnosis of NF and ABC.
Cement-induced intracardiopulmonary embolism is an uncommon but potentially serious complication after percutaneous kyphoplasty (PKP). Early recognition and timely intervention are therefore critical. We report a series of five patients with intracardiopulmonary cement embolism after PKP. For emergency physicians, cement embolism should remain an important diagnostic consideration in patients with recent PKP, particularly elderly women who present with chest discomfort or otherwise unexplained hypotension. Failure to elicit a recent history of PKP may therefore delay diagnosis. Symptomatic cement embolism may deteriorate rapidly and requires prompt hemodynamic stabilization, respiratory support, and early imaging. CT or bedside ultrasonography is essential for identifying pulmonary cement embolism and cardiac perforation. Early multidisciplinary consultation should be initiated to determine whether the patients need surgical or endovascular embolectomy.
The pelvis is one of the common sites of metastatic tumors. Due to the wide variety of primary tumor origins and differences in tumor malignancy and the degree of bone destruction, clinical decision-making for pelvic metastatic tumors is complex, and there is a lack of unified diagnostic and treatment guidelines both domestically and internationally. To standardize the surgical treatment of pelvic metastatic tumors in China, the Bone Tumor Group of the Orthopedics Branch of the Chinese Medical Association and the Professional Committee on Bone Tumors and Bone Metastasis of the China Anti-Cancer Association organized renowned bone tumor experts in China to develop this consensus based on existing evidence and clinical experience, using a modified Delphi method. This consensus provides recommendations on core clinical issues, including preoperative evaluation, surgical approaches, postoperative rehabilitation, and perioperative management, aiming to offer practical guidance for clinical practitioners and ultimately improve patient outcomes. 骨盆是恶性肿瘤常见的转移部位。由于原发肿瘤来源广泛，肿瘤恶性程度以及造成的骨骼破坏程度各不相同，骨盆转移瘤临床决策复杂，国内外尚缺乏统一的诊疗规范。为规范我国骨盆转移瘤的手术治疗，中华医学会骨科学分会骨肿瘤学组、中国抗癌协会骨肿瘤和骨转移瘤专业委员会组织国内知名骨肿瘤专家，基于现有证据与临床经验，采用改良德尔菲法制订了本共识。共识围绕术前评估、手术方式、术后康复及围手术期管理等核心临床问题形成推荐意见，旨在为临床医务人员提供实践指导，最终改善患者预后。.
Age-related decline in male testosterone is associated with reduced bone and muscle mass, increased fat mass, and impaired quality of life. This study investigated the relationships between serum total testosterone (T) levels and bone mineral density, body composition, spinal muscle morphology, and low back pain-related disability in patients undergoing spine surgery. Male patients who underwent spine surgery at our institution and had preoperative serum total testosterone (total T) levels measured were included in this study. Pearson's correlation coefficients were used to assess associations between total T and bone metabolism markers, body composition, physical function, spinal muscle cross-sectional areas (CSAs) on MRI, and clinical outcomes including the Roland-Morris Disability Questionnaire (RDQ) and Aging Males' Symptoms (AMS) scale. Multiple linear regression analysis was performed to identify independent associations. Thirty-eight patients (mean age 73.7 years) were included. Total T levels correlated negatively with age (r = -0.35, P < 0.05). Positive correlations with total T levels were observed for CSAs of the psoas major (r = 0.49, P < 0.05) and paraspinal muscles (r = 0.58, P < 0.05). RDQ scores were negatively correlated with total T levels both preoperatively (r = -0.48, P < 0.05) and postoperatively (r = -0.64, P < 0.05). The improvement rate for RDQ was positively correlated (r = 0.35, P < 0.05) and AMS scores were negatively correlated with total T levels (r = -0.35, P < 0.05). In contrast, no significant associations were observed with body fat percentage, bone mineral density, bone turnover markers, grip strength, or skeletal muscle mass. In multivariate analysis, total T was independently associated with paraspinal muscle CSA but not psoas CSA, after adjustment for age. Lower serum total T levels are independently associated with paraspinal muscle atrophy and greater low back pain-related disability in elderly men undergoing spine surgery. Serum total T may serve as a clinically useful biomarker of musculoskeletal status and predictor of postoperative functional outcomes.
This study evaluated the biomechanical performance of 3 fixation systems-L-shaped miniplates, prebent plates, and a single-piece patient-specific plate (PSP)-for maxillary stabilization following Le Fort I osteotomy using finite element analysis. A three-dimensional finite element model of the maxilla was constructed from computed tomography data of a patient with maxillary deficiency. Simulated Le Fort I osteotomies included 5 mm maxillary advancement and 6 mm downgrafting, with iliac bone grafts placed between the segments. Fixation was achieved using 4 L-shaped miniplates, 2 prebent plates, or a single-piece PSP. Vertical (500 N) and oblique (250 N) masticatory loads were applied. Von Mises stress on plates and screws, maximum principal stress in bone and graft, and total segment displacement were assessed. The prebent plate model exhibited the highest von Mises stress on fixation plates under vertical loading (135.596 MPa). The single-piece PSP demonstrated the lowest displacement values in all directions, indicating superior segmental stability. Although slightly higher screw (88.379 MPa) and bone stress (14.835 MPa) values were observed in the PSP model, all stresses remained below physiological and material safety thresholds. Graft stress values were comparable to those of surrounding bone under both oblique (6.229-6.621 MPa) and vertical loading (8.385-9.127 MPa). All fixation systems provided adequate mechanical performance; however, the single-piece PSP showed more favorable stress distribution and stability, supporting its use as a biomechanically advantageous fixation option in orthognathic surgery.
The circuit of interoception, through which the nervous system monitors internal physiological states and maintains tissue homeostasis, has been well characterized in bone. However, whether a comparable interoceptive mechanism exists in the other mineralized tissue-teeth-remains unknown. This review uses skeletal interoception as a comparative framework to examine whether analogous sensory-regulatory mechanisms may operate in dental tissues. We summarize the neuroanatomical basis of dental innervation, the peripheral cellular mechanisms by which the pulp-dentine complex and periodontal ligament-alveolar bone complex sense and transduce local tissue states, and the reciprocal neural and effector responses that may contribute to dental homeostasis. Based on current evidence, we propose 'dental interoception' as a hypothetical conceptual framework for understanding neural-cellular regulation in teeth and their supporting tissues. The literature search was conducted in the PubMed and Web of Science databases, with a focus on how dental cells sense local tissue-state changes and communicate with the nervous system, as well as the direct regulation on odontogenesis-related cells by the nervous system. Current evidence suggests two potential modules of dental interoception: a pulp-dentine module that monitors intradental tissue states and supports pulp repair and reparative dentinogenesis, and a periodontal ligament-alveolar bone module that senses tooth load and regulates occlusal adaptation and alveolar bone remodelling. These modules involve pulpal cell-trigeminal nerve communication, reciprocal neural regulation of pulpal vascular, immune, stem-cell and reparative responses, and periodontal mechanoreceptor-guided remodelling. However, whether they form a complete peripheral-central-peripheral feedback loop remains unresolved. The bidirectional regulation between the nervous system and dental tissues is fundamental for maintaining dental homeostasis. Mapping the full circuitry underlying this interaction will be essential to establish dental interoception as a coherent physiological concept.
While frequently sporadic or genetic in etiology, craniosynostosis may occur secondarily due to underlying defects in bone mineralization. X-linked hypophosphatemia represents a common genetic cause of rickets, with sequelae including craniosynostosis and Chiari malformation type I (CM-I). In contrast, severe nutritional vitamin D deficiency-induced rickets represents a rare cause of acquired or postnatal craniosynostosis and CM-I, with few cases reported in the published literature. The authors present the case of a 2-year-old boy with a history of severe vitamin D deficiency rickets who presented with multisuture craniosynostosis, acquired CM-I, and clinical symptoms and signs of increased intracranial pressure (ICP). His headaches and papilledema resolved with cranial vault expansion and bone-only posterior fossa decompression. By the time of his presentation with craniosynostosis, his vitamin D deficiency had been treated and resolved for about 1 year. Secondary or postnatal craniosynostosis often does not present with characteristic head shape changes but may be associated with elevated ICP and acquired CM-I, which may require surgical intervention. Late presentation or diagnosis of craniosynostosis in young children without typical features should prompt investigation for underlying disorders of bone metabolism. https://thejns.org/doi/10.3171/CASE26200.