Osteosarcoma is characterised by reduced expression of markers of osteoclastogenesis and antigen presentation compared with normal bone.

BACKGROUND: Osteosarcoma (OS) is the most common primary bone tumour in children and adolescents. Patients who respond poorly to chemotherapy have a higher risk of metastatic disease and 5-year survival rates of only 10-20%. Therefore, identifying molecular targets that are specific for OS, or more specifically, metastatic OS, will be critical to the development of new treatment strategies to improve patient outcomes. METHODS: We performed a transcriptomic analysis of chemo-naive OS biopsies and non-malignant bone biopsies to identify differentially expressed genes specific to OS, which could provide insight into OS biology and chemoresistance. RESULTS: Statistical analysis of the OS transcriptomes found differential expression of several metallothionein family members, as well as deregulation of genes involved in antigen presentation. Tumours also exhibited significantly increased expression of ID1 and profound down-regulation of S100A8, highlighting their potential as therapeutic targets for OS. Finally, we found a significant correlation between OS and impaired osteoclastogenesis and antigen-presenting activity. The reduced osteoclastogenesis and antigen-presenting activity were more profound in the chemoresistant OS samples. CONCLUSION: Our results indicate that OS displays gene signatures consistent with decreased antigen-presenting activity, enhanced chemoresistance, and impaired osteoclastogenesis. Moreover, these alterations are more pronounced in chemoresistant OS tumour samples.

Primary malignant tumours of bone following previous malignancy.

Destructive bone lesions occurring in patients who have previously had a malignancy are generally assumed to be a metastasis from that malignancy. We reviewed 60 patients with a previous history of malignancy, who presented with a solitary bone lesion that was subsequently found to be a new and different primary sarcoma of bone. These second malignancies occurred in three distinct groups of patients: (1) patients with original tumours well known to be associated with second malignancies (5%); (2) patients whose second malignancies were likely to be due to the previous treatment of their primary malignancy (40%); (3) patients in whom there was no clearly defined association between malignancies (55%). The purpose of this study is to emphasise the necessity for caution in assuming the diagnosis of a metastasis when a solitary bone lesion is identified following a prior malignancy. Inappropriate biopsy and treatment of primary bone sarcomas compromises limb salvage surgery and can affect patient mortality.

Contamination of banked femoral head allograft: incidence, bacteriology and donor follow up.

BACKGROUND: Allograft donations are not uncommonly found to be contaminated. The issue of contaminated donations from live donors at the time of surgery, and the significance of this to the patient in terms of subsequent sepsis of the arthroplasty, were examined. METHODS: The donations of femoral heads to the Queensland Bone Bank over a 9-year period were reviewed, and the incidence and bacteriology of contamination were detailed. Clinical outcomes were determined for donors who had positive cultures at the time of retrieval and they were compared with those of culture-negative donors. RESULTS: Between March 1987 and February 1996, 232 femoral heads were donated to the Queensland Bone Bank. Four specimens were sent for culture with each femoral head (surface swab of femoral head, acetabular swab, bone biopsy and capsule). In 51 cases, one or more positive cultures were obtained (22% contamination rate). The majority of organisms cultured were Staphylococcus epidermidis. One hundred and seventy donations came from surgery performed at the Princess Alexandra Hospital, and 40 femoral heads were considered contaminated. Deep infection was recorded in one of the 40 cases with contaminated donations and three out of 130 non-contaminated donations had subsequent septic episodes. CONCLUSION: The contamination rate detailed in the present report is higher than in most series. This may be due to the fact that four bacteriological specimens are taken to assess contamination. Two of these specimens are tissue samples which yielded more positive results than did the two swabs. All other series take no more than two bacteriological specimens, which are usually bone swabs. These are shown to have a poor yield of positive cultures. Therefore there is a significant underestimation of contamination rates by other bone banks. This has implications for the recipients of bone from those banks, particularly when the allograft material is not secondarily sterilized. This is important given increasing allograft usage, and the increasing numbers of revision joint arthroplasty and impaction grafting procedures being performed. Sterilization of all bone by irradiation to 25 kGy is recommended.

The nursing shortage: implications for perianesthesia nursing in the 21st century.

Nursing shortages are not a new problem, and in fact, seem to come around on an almost cyclical basis. Although nursing shortages are not unusual, this first shortage of the 21st century exhibits unique characteristics that could undermine the very fiber of nursing, and healthcare in general. Members of the ASPAN Board of Directors attended the Nursing Shortage: Practical Solutions Conference conducted by The Forum on Health Care Leadership and sponsored by Cross Country University (a continuing education company part of Cross Country Staffing, Boca Raton, FL) and Curtin Calls, held in September of 1999 (Ft Lauderdale, FL). This article provides an overview of information gathered at that conference and will also explore the challenges and opportunities that this shortage poses to the specialty of perianesthesia nursing.

Bacterial contamination rates during bone allograft retrieval.

A retrospective study of allograft bone retrieved from 401 donors between January 1987 and March 1996 was performed to determine the incidence of bacterial contamination. Contamination according to type of donor (live, multiorgan, cadaveric) was also determined. Live donors donating a femoral head demonstrated a contamination rate of 13%; multiorgan donors, 24%; and cadaveric donors, 35%. Donor contamination by type of bone (hemipelvis, femur, tibia) showed no significant difference in the multiorgan donors. In cadaveric donors, there was a significant increase in contamination of the hemipelves as compared to the femur and tibias. Recommendations for contamination control in allograft retrieval are given. Our findings are of great significance for musculoskeletal banks that do not secondarily irradiate and rely on screening of allograft bone for contamination alone.

Weight, corticosterone and glucose: changes with time of day after food deprivation.

The effects of constant food deprivation, terminated at different times of day were examined with respect to percent body weight loss (%BWL), plasma corticosterone (PC) and plasma glucose (PG). A 19-hour food deprivation paradigm schedule staggered around varying times of the day-night cycle was used. Patterns of %BWL related to nocturnal lipogenesis and diurnal lipolysis showed the greatest loss (10%) occurring at 0700 hr, while in evening hours, there was an increasing pattern of weight loss, with the greatest amount (7%) occurring at 2200 hr. A pattern suggestive of neuroregulatory cycles of glucocorticoid release was evident for PC levels; maximum levels for PC (23.2 micrograms%) were reported at 0700 hr and at 1900 hr (16.6 micrograms%). Similar patterns were also noted in PG levels, with respective maximum levels of 138.0 mg% and 125.8 mg% occurring at 0700 hr and 1900 hr. These results indicate that the time of day that a deprivation schedule is initiated and terminated is an important consideration due to the impact of circadian photoperiodism. Time of day should be an essential consideration when utilizing deprivation paradigms.