The role of autophagy in the treatment of osteoporosis by Chinese medicines(natural)

Osteoporosis is one of the common orthopaedic diseases,characterised by increased bone fragility due to reduced bone mass and microstructural degeneration,posing a great threat to patients’quality of life and safety.In recent years,Chinese medicine(natural)has had a unique advantage in the treatment of osteoporosis and has shown good efficacy.Autophagy is an inherent cellular survival mechanism for the removal and recycling of damaged proteins and organelles and plays an important role in maintaining the stability of the intracellular environment and organ function.Therefore,this article aims to provide a comprehensive review of these Chinese medicines(natural)for the treatment of osteoporosis through autophagy.They have been intensively studied and reported to have effects such as promoting osteogenesis and anti-bone resorption.The Chinese medicines include plants such as Cistanche deserticola,Epimedium,Curculigo orchioides Gaertn,Achyranthes bidentata Blume,Leonurus japonicus Houtt,Ginseng,Chuanxiong Rhizome,Eucommia ulmoides,Morindae Officinalis Radix,Curcuma longa,Polygoni Cuspidati Rhizoma et Radix,Anemarrhena asphodeloides Bunge,Salvia miltiorrhiza Bge and Pueraria Lobata,thus providing evidence for the use of alternative herbal therapies for the effective treatment of osteoporosis.

Myeloid sarcoma with ulnar nerve entrapment:A case report

BACKGROUND Myeloid sarcoma(MS) is relatively rare,occurring mainly in the skin and lymph nodes,and MS invasion of the ulnar nerve is particularly unusual.The main aim of this article is to present a case of MS invading the brachial plexus,causing ulnar nerve entrapment syndrome,and to further clinical understanding of the possibility of MS invasion of peripheral nerves.CASE SUMMARY We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger.The initial diagnosis was considered a simple case of nerve entrapment disease,with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening,entrapment,and high signal on compression lipid images.Due to the severity of the ulnar nerve compression,we surgically investigated and cleared the entrapment and nerve tissue hyperplasia;however,subsequent pathological biopsy results revealed evidence of MS.The patient had significant relief from his neurological symptoms,with no postoperative complications,and was referred to the haemato-oncology department for further consultation about the primary disease.This is the first report of safe treatment of ulnar nerve entrapment from MS.It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS,as a rare presenting feature of the disease.CONCLUSION MS invasion of the brachial plexus and surrounding tissues of the upper arm,resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger,is uncommon.Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment.This case is reported to highlight the rare presenting features of MS.

Giant schwannoma of thoracic vertebra: A case report

BACKGROUND It is relatively rare for schwannomas to invade bone,but it is very rare for a large mass to form concurrently in the paravertebral region.Surgical resection is the only effective treatment.Because of the extensive tumor involvement and the many important surrounding structures,the tumor needs to be fully exposed.Most of the tumors are completely removed by posterior combined open-heart surgery to relieve spinal cord compression,restore the stability of the spine and maximize the recovery of nerve and spinal cord function.The main objective of this article is to present a schwannoma that had invaded the T5 and T6 vertebral bodies and formed a large paravertebral mass with simultaneous invasion of the spinal canal and compression of the spinal cord.CASE SUMMARY A 40-year-old female suffered from intermittent chest and back pain for 8 years.Computed tomography and magnetic resonance imaging scans showed a paravertebral tumor of approximately 86 mm×109 mm×116 mm,where the adjacent T5 and T6 vertebral bodies were invaded by the tumor,the right intervertebral foramen was enlarged,and the tumor had invaded the spinal canal to compress the thoracic medulla.The preoperative puncture biopsy diagnosed a benign schwannoma.Complete resection of the tumor was achieved by a two-step operation.In the first step,the thoracic surgeon adopted a lateral approach to separate the thoracic tumor from the lung.In the second step,a spine surgeon performed a posterior midline approach to dissect the tumor from the vertebral junction through removal of the tumor from the posterior side and further resection of the entire T5 and T6 vertebral bodies.The large bone defect was reconstructed with titanium mesh,and the posterior root arch was nail-fixed.Due to the large amount of intraoperative bleeding,we performed tumor angioembolization before surgery to reduce and avoid large intraoperative bleeding.The postoperative diagnosis of benign schwannoma was confirmed by histochemical examination.There was no sign of tumor recurrence or spinal instability during the 2-year follow-up.CONCLUSION Giant schwannoma is uncommon.In this case,a complete surgical resection of a giant thoracic nerve sheath tumor that invaded part of the vertebral body and compressed the spinal cord was safe and effective.

On the mechanical aspect of additive manufactured polyether-ether-ketone scaffold for repair of large bone defects

Polyether-ether-ketone(PEEK)is widely used in producing prosthesis and have gained great attention for repair of large bone defect in recent years with the development of additive manufacturing.This is due to its excellent biocompatibility,good heat and chemical stability and similar mechanical properties which mimics natural bone.In this study,three replicates of rectilinear scaffolds were designed for compression,tension,three-point bending and torsion test with unit cell size of 0.8 mm,a pore size of 0.4 mm,strut thickness of 0.4 mm and nominal porosity of 50%.Stress-strain graphs were developed from experimental and finite element analysis models.Experimental Young’s modulus and yield strength of the scaffolds were measured from the slop of the stress-strain graph to be 395 and 19.50 MPa respectively for compression,427 and 6.96 MPa respectively for tension,257 and 25.30 MPa respectively for three-point bending and 231 and 12.83 MPa respectively for torsion test.The finite element model was found to be in good agreement with the experimental results.Ductile fracture of the struct subjected to tensile strain was the main failure mode of the PEEK scaffold,which stems from the low crystallinity of additive manufacturing PEEK.The mechanical properties of porous PEEK are close to those of cancellous bone and thus are expected to be used in additive manufacturing PEEK bone implants in the future,but the lower yield strength poses a design challenge.