Bone destruction of orbital wall in idiopathic orbital inflammatory pseudotumor:does it always imply malignancy?

AIM:To assess the clinical presentations and outcomes of idiopathic orbital inflammatory pseudotumor(IOIP)patients with orbital wall bone destruction(OWBD)and to propose an expanded classification system that includes bone destruction.METHODS:The study retrospectively reviewed clinical presentations,imaging findings,treatment modalities,and outcomes of six patients diagnosed histopathologically with IOIP and OWBD at the Beijing Tongren Hospital,Capital Medical University between October 2018 and June 2021.RESULTS:Over two years,6(10%)of 60 IOIP patients at our hospital exhibited OWBD,but this may overrepresent severe cases.The cohort consisted of three men and three women,aged 17 to 60y(mean 35.5±16.1y).Presenting symptoms included proptosis,eyelid swelling,decreased visual acuity with pain,and palpable mass.Imaging revealed multiple anatomical structures involved with the medial wall being the most common site of bone destruction.Histopathological examination showed classic type in five patients and sclerosing type in one patient.All patients underwent surgical resection followed by methylprednisolone treatment.Follow-up(mean 30.3±3.1mo)indicated three patients had no recurrence,while others had varying degrees of symptom persistence or recurrence.CONCLUSION:IOIP with bone destruction is a rare but significant subtype that mimics malignancy,leading to potential diagnostic and therapeutic challenges.Our findings suggest that complete surgical resection combined with adjunctive glucocorticoid therapy can yield favorable outcomes.However,larger-scale studies are needed to further optimize therapeutic approaches.

Fibrous hamartoma of infancy with bone destruction of the tibia:A case report

BACKGROUND Fibrous hamartoma of infancy(FHI)is a rare disease of infancy with unknown etiology.The disease mainly involves soft tissue,has no specific clinical manifestations,and is difficult to diagnose.At present,the diagnosis is mainly confirmed by histopathological examination,and the main treatment is surgical resection of the pathological tissue,which is prone to recurrence.CASE SUMMARY A five-month-old female patient was admitted to our hospital with swelling in the right calf.Two biopsies were performed in our hospital and another hospital,respectively,confirming the diagnosis as fibrous hamartoma.After exclusion of surgical contraindications,resection was performed with clear margins of 1 cm.Radiographic examination showed tumor recurrence more than four months after the operation,and surgery was performed again to extend the resection margins to 1.5 cm.The patient is recovering well,and after a follow-up of 36 mo,shows no signs of recurrence.CONCLUSION Our case report demonstrates that FHI should be considered in the differential diagnosis for a lower extremity mass with bone destruction.For FHI with bone destruction and unclear boundaries,excision margins of 1.5 cm could be superior to margins of 1 cm.

Effect of traditional Chinese medicine on rheumatoid arthritis bone destruction:A systematic review and meta-analysis

Objective:To systematically evaluate the efficacy of Traditional Chinese medicine for improving bone damage in rheumatoid arthritis(RA),and provide guidance for clinical treatment.Methods:computer retrieval China hownet database(CNKI),Chinese biomedical literature retrieval(SinoMed),ten thousand Data knowledge service system(WanFang Data),VIP full-text database(VIP),PubMed,MedLine and the cochrane library,collect relevant Chinese medicine for the treatment of rheumatoid arthritis,bone destruction randomized controlled trial(RCT),screening from built by researchers at the two libraries to literature in February 2020,to extract the required indicators,and incorporated into RevMan 5.2 analysis.Results:a total of 1291 patients were included in 14 RCTS.The results of meta-analysis showed that compared with the control group,The traditional Chinese medicine treatment group could improve the 25-hydroxyvitamin D of patients with RA bone damage,which was better than the western medicine control group,and the difference was statistically significant.TCM treatment group can improve the balance between osteoblasts and osteoclasts(nuclear factor B receptor activating factor;Bone mineral density;Bone alkaline phosphatase;Bone protectin;(osteocalcin),and was superior to the western medicine control group,the difference was statistically significant;(3)traditional Chinese medicine treatment group can improve RA patients with bone destruction of the balance of osteoblast and osteoclast(Ⅰtype collagen amino terminal propeptide before;Carboxy-terminal peptide of collagen;The effect of nuclear factor B receptor activator factor and bone protectin was similar to that of the western medicine control group,and the difference was not statistically significant.Conclusion:At present,the existing evidence can prove that Traditional Chinese Medicine in the treatment of rheumatoid arthritis bone damage has an exact effect,regulate the function of osteoblasts and osteoclasts,improve the level of bone metabolism of patients,prevent the progress of bone damage.

A potential role of circular RNAs in bone destruction of rheumatoid arthritis

Bone destruction in rheumatoid arthritis(RA)is a pathological state that always accompanies the development of RA patients,which will cause severe deformation of their joints and decline in quality of life.Circular RNAs(circRNAs)are a class of RNA molecules with circular structure,which are widely existed in a variety of organisms and play special biological functions in a variety of diseases.There has been evidence that circRNAs can act as miRNA sponges and play an important role in the treatment of bone destruction in RA.In this paper,the potential relationship between circRNAs and bone destruction in RA was discussed in terms of the regulation of cell apoptosis,osteoblast and osteoclast differentiation,and the regulation of immune inflammation,so as to provide a new approach for studying the potential mechanism of bone destruction in RA and possible therapeutic methods.

Huangqi Guizhi Wuwu Decoction suppresses inflammation and bone destruction in collagen-induced arthritis mice

Objective: Rheumatoid arthritis(RA) is a chronic inflammatory and destructive arthritis, characterized by inflammatory infiltration and bone destruction. Huangqi Guizhi Wuwu Decoction(HGWD) is traditional Chinese medicine, which has been applied in the treatment of RA in clinical. The aim of this study was to investigate the therapeutic effect of HGWD on collagen-induced arthritis(CIA) mouse model.Methods: DBA/1J female mice were used to establish the collagen-induced arthritis(CIA) model. HGWD was administered intragastrically once a day for four weeks starting on the 22nd day after the first immunization. The body weight, hind paw thickness and clinical score were measured every five days. Gait analysis, histopathological staining, enzyme-linked immunosorbent assay(ELISA), ultrasound imaging and micro-computed tomography imaging were performed to determine the effects of HGWD treatment on inflammation and bone structure in this model. Moreover, Real-time PCR and Western blot analysis were used to detect inflammatory factors m RNA and protein levels after HGWD intervention in RAW264.7 cells.Results: HGWD attenuated symptoms of arthritis, suppressed inflammatory synovium area and the serum levels of inflammatory factors, inhibited joint space enlargement in the knee and ankle joints,reduced numbers of osteoclasts, protected bone destruction, as well as improved motor function.HGWD decreased the expression of m RNA for inflammatory factors and the protein expression levels of p-NF-ΚB and IL-17.Conclusion: These results suggested that HGWD suppresses inflammation, attenuates bone erosion and maintains motor function in collagen-induced arthritis mice.

Effect of Sangu Decoction(三骨汤) on Metastatic Bone Destruction in Rats with Mammary Cancer

Objective： To study and evaluate the effect of Sangu Decoction （SGD, 三骨汤） on the bone destruction due to mammary cancer metastasis. Methods： Metastasis rat mammary tumor-1 cells were transplanted into the left hind limb tibia of SD rats to establish the bone metastasis of the mammary cancer model. The modeled rats were treated with SGD for observing its effect on rats＇ pain behavior, including 50% paw withdrawal threshold （50% PWT） after von Frey fiber stimulation, burden difference of bilateral feet, and thermal withdrawal latency （TWL）, with zoledronic acid as the positive control. Moreover, the damage in the tibia sample of rats was scored by an iconographic method, and the bone mineral density （BMD） as well as the bone mineral content （BMC） were estimated. Results： The model established showed characteristics of mixed metastasis, revealing the manifestations of tumor development, bone destruction, cancerous pain, etc. In the SGD-treated group, 50% PWT was prolonged （8.13±4.76 vs. 2.30±2.19）, and TWL was longer （3.48±0.62 s vs. 2.89± 0.26 s） than those in the control group, respectively （P〈0.05 or P〈0.01）. Iconographic scoring also showed improvement of BMD （0.134±0.009 vs. 0.120±0.007, P〈0.01） and an elevating trend of BMC in the SGD-treated group. Conclusion： SGD could effectively alleviate the cancerous pain of bone metastasis and mitigate the metastasis that cause osteolytic destruction of bone.

The role of dendritic cells derived osteoclasts in bone destruction diseases

The bone is previously considered as a dominant organ involved in the processes of locomotion.However,in the past two decades,a large number of studies have suggested that the skeletal system closely coordinated with the immune system so as to result in the emerging area of'osteoimmunology'.In the evolution of many kinds of bone destruction-related dis-eases,osteoclasts could differentiate from dendritic cells,which contributed to increased expression of osteoclast-related membrane receptors and relatively higher activity of bone destruction,inducing sewere bone destruction under inflammatory conditions.Numerous fac-tors could influence the interaction between osteoclasts and dendritic cells,contributing to the pathogenesis of several bone diseases in the context of inflammation,including both im-munocytes and a large number of cytokines.In addition,the products of osteoclasts released from bone destruction area serve as important signals for the differentiation and activation of immature dendritic cells.Therefore,the border between the dendritic cell-rela ted immune response and osteoclast-related bone destruction has gradually unravelled.Dendritic cells and osteoclasts cooperate with each other to mediate bone destruction and bone remodelling under inflammatory conditions.In this review,we will pay attention to the interactions be-tween dendritic cells and osteoclasts in physiological and pathological conditions to further understand the skeletal system and identifty potential new therapeutic targets for the future by summarizing their significant roles and molecular mechanisms in bone destruction.

miR-483-5p regulates osteoclast generation by targeting Timp2

Objective:To investigate whether miR-483-5p regulates osteoclast generation by targeting Timp2.miR-483-5p can promote osteoclast differentiation and bone destruction.Methods:Target genes of miR-483-5p were predicted by miRNAs target gene prediction software TargetScan8.0,and wild type and mutant 3'UTR plasmids were constructed.Dual luciferase reporter genes were used to verify whether target genes had a targeted regulatory relationship with miR-483-5p.Western blotting was used to detect the corresponding changes in the expression level of target protein after adjusting the level of miR-483-5p in cells.Cells were transfected or infected with target gene siRNA or target protein lentivirus,and TRAP staining and q-PCR assays were performed.In addition,for osteoclast induction experiment,RAW264.7 cells were co-transfected with ago-miR-483-5p and target protein-overexpressed lentiviruses q-PCR and TRAP staining were performed respectively.Results:Bioinformatics software was used to predict the target gene of miR-483-5p,and the Timp2 gene was found to regulate osteoclasts,and the dual luciferase reporter detection system found that miR-483-5p could be associated with the 3-UTR of the predicted target gene Timp2 gene.There are complementary loci and targeted regulatory relationship between them.Subsequently,we upregulated miR-483-5p in RAW264.7 cells to reduce the expression of Timp2.Compared with the normal group,the number of osteoclasts and the expression of osteoclast-specific genes increased significantly after the induction of Timp2 in knockdown cells.After co-transfection of target gene and miR-483-5p into cells,the number of osteoclasts and the expression of specific genes decreased significantly compared with the normal group.Conclusion:Timp2 is a downstream target gene of miR-483-5p and is involved in and inhibits osteoclast generation.

Clinical characteristics and risk factors of Talaromyces marneffei infection in human immunodeficiency virus-negative patients: A retrospective observational study

BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.

Non-secretory multiple myeloma expressed as multiple extramedullary plasmacytoma with an endobronchial lesion mimicking metastatic cancer:A case report

BACKGROUND Non-secretory multiple myeloma(MM)is a rare condition that accounts for only 3%of MM cases and is defined by normal serum and urine immunofixation and a normal serum free light chain ratio.Non-secretory MM with multiple extramedullary plasmacytomas derived from endobronchial lesions is extremely rare and can be misdiagnosed as metastasis of solid cancer.CASE SUMMARY A 36-year-old man presented with progressive facial swelling and nasal congestion with cough.Various imaging studies revealed an endobronchial mass in the left bronchus and a large left maxillary mass with multiple destructive bone metastatic lesions.He initially presented with lung cancer and multiple metastases.However,pathologic reports showed multiple extramedullary plasmacytomas in the left maxilla and the left bronchus.There was no change in the serum and urine monoclonal protein levels,and no abnormalities were observed in laboratory examinations,including hemoglobin,calcium,and creatinine levels.The bone marrow was hypercellular,with 13.49%plasma cells.The patient was diagnosed with non-secretory MM expressed as multiple extramedullary plasmacytomas with endobronchial lesions in a rare location.Radiation therapy for symptomatic lesions with high-dose dexamethasone was started,and the size of the left maxillary sinus lesion dramatically decreased.In the future,chemotherapy will be administered to control lesions in other areas.CONCLUSION We present a rare case of non-secretory MM with multiple extramedullary plasmacytoma with an endobronchial lesion.

THE DESTRUCTION OF BONE BY NEUTROPHILS

Osteomyelitis is characterized by rapid bone degradation at the infection site. Although osteoclasts may be activated by prostaglandins elaborated by bacteria or by osteoclast and activating factor and interleukin-1 released by lymphocytes, they are rarely observed in the histology of acute osteomyelitis in which neutrophils predominate. We investigated the hypothesis that the rapid resorption of bone in acute osteomyelitis is mediated by neutrophils.

New perspectives on traumatic bone infections

In this paper,we review the results of previous studies and summarize the effects of various factors on the regulation of bone metabolism in traumatic bone infections.Infection-related bone destruction incorporates pathogens and iatrogenic factors in the process of bone resorption dominated by the skeletal and immune systems.The development of bone immunology has established a bridge of communication between the skeletal system and the immune system.Exploring the effects of pathogens,skeletal systems,immune systems,and antibacterials on bone repair in infectious conditions can help improve the treatment of these diseases.

Aneurysmal bone cyst of the maxilla rare presentation with radiological and pathological correlation

The incidence of aneurysmal bone cyst in the maxillofacial region is rare and may remain undiagnosed for a long period prior to becoming symptomatic.This may cause associated issues secondary to compression by extending to the surrounding vital anatomical areas.An aggressive course can lead to bony destruction with intracranial extension.We present a case of a 23-year-old man who presented with bilateral exorbitism with nasal obstruction.

A One-year Evaluation of Radiographic Progression in Patients with Rheumatoid Arthritis Treated by Qingre Huoxue Decoction(清热活血方)

Objective： TO investigate the effects of Qingre Huoxue Decoction （清热活血方, clearing heat and promoting blood flow; QRHXD）, on the radiographic progression in patients with rheumatoid arthritis （RA） by X-ray imaging. Methods： Eighty-six patients with active RA diagnosed as damp-heat and blood stasis syndrome were randomized into a QRHXD group and a QRHXD plus methotrexate （MTX） group, with 43 cases in each group. After one-year of treatment, 21 cases in each group （42 in total） were evaluated. Radiographs of hands were obtained at the baseline and after 12 months of treatment. Images were evaluated by investigators blinded to chronology and clinical data, and assessed according to the SharpNan der Heijde methods. Results： High intrareader agreements were reached （mean intraobserver intraclass coefficients： 0.95）. No significant change in any imaging parameters of joint destruction was observed at 12 months in either group; and the differences between the two groups were not significant （P〉0.05）. The mean of the changing score in the QRHXD group was 3.5 ± 4.1, and 2.4 ± 3.5 in the QRHXD＋MTX group, while the baseline radiographic score of patients in the QRHXD group was relatively higher （18.9± 19.1 vs. 14.0± 14.0）. The mean rates of the changing scores of the two groups were similar （0.24 ± 0.28 vs. 0.25± 0.44, P=0.40）. The severity of progression in the two groups was also similar （P=0.46）, 7 cases without radiographic progression in the QRHXD group and 8 in the QRHXD＋MTX group, 3 cases with obvious radiographic progression in the QRHXD group and 1 in the QRHXD＋MTX group. Conclusion： Radiographic progression of RA patients in both groups is similar, indicating that the QRHXD Decoction has a potential role in preventing bone destruction.