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Myeloid cells including microglia and macrophages play crucial roles in retinal homeostasis by clearing cellular debris and regulating inflammation. These cells are activated in several blinding ischemic retinal diseases including diabetic retinopathy, where they may exert both beneficial and detrimental effects on neurovascular function and angiogenesis. Myeloid cells impact the progression of retinal pathologies and recent studies suggest that targeting myeloid cells is a promising therapeutic strategy to mitigate diabetic retinopathy and other ischemic retinal diseases. This review summarizes the recent advances in our understanding of the role of microglia and macrophages in retinal diseases and focuses on the effects of myeloid cells on neurovascular injury and angiogenesis in ischemic retinopathies. We highlight gaps in knowledge and advocate for a more detailed understanding of the role of myeloid cells in retinal ischemic injury to fully unlock the potential of targeting myeloid cells as a therapeutic strategy for retinal ischemia. [ABSTRACT FROM AUTHOR]

The paper builds on recent flexitarianism scholarship by approaching this heterogeneous dietary category as a socio-cultural and political economic, rather than just a psychological phenomenon. It does this by drawing on Edmund Harris’s conceptualization of alternative food provisioning activities and subject-making as a “politics of the possible.” The paper addresses the following questions: does flexitarianism and the making of flexitarian subjectivities represent a “politics of the possible” and if so how; what are the limits of these politics and how might these limits be overcome? Empirically, the paper undertakes a qualitative analysis of UK national print news media coverage of flexitarianism and semi-structured interviews with self-identified flexitarians. Data from these two sources are interwoven in the discussion of themes that provide some evidence in support of flexitarianism as a politics of the possible, but which also draw attention to the limits of these politics. The paper concludes that only by addressing these limits can a full and critical assessment be made of flexitarianism’s contribution to a food system less dependent on animal-based foods. [ABSTRACT FROM AUTHOR]

Recent years have seen an increase in actions to address a key feature of food in the Anthropocene: the over‐production and consumption of animal‐based foods or "animalisation" of diets. However, it is unclear whether such efforts can be understood as a coherent institutional level response that will challenge hegemonic dietary biopower, a regime of governance that normalises and reproduces animal‐based food consumption. Building on scholarship that explores food governance initiatives in urban contexts and dietary biopower across a range of empirical cases, this paper explores whether, how, and with what consequences governance actors within urban food partnerships (UFPs) of the UK Sustainable Food Cities (SFC) network are working to reframe dietary biopower so that humans are disciplined to eat less animal‐based food and instead to adopt a more plant‐centred diet. Document analysis and semi‐structured interviews with SFC representatives suggest the breadth and depth of current UFP actions do not add up to a sustained challenge to hegemonic, animal‐based dietary biopower. Rather, they reveal a plant‐centred dietary biopolitical project in the making, while specific cases suggest that this project is more accurately conceptualised as arrested due to the pursuit of food system actions that are counter to and in tension with the promotion of plant‐centred eating. We suggest that a more coherent reframing of dietary biopower would entail urban food governance actors engaging consistently and robustly with the debates surrounding animal‐based foods, as well as identifying and enacting synergies between plant‐centred eating, food poverty, and local economic development agendas. The paper explores whether, how and with what consequences governance actors within the urban food partnerships of the UK Sustainable Food Cities network are working to reframe dietary biopower so that humans are disciplined to eat less animal‐based food and instead to adopt a more plant‐centred diet. [ABSTRACT FROM AUTHOR]

The desire to govern antimicrobial resistance (AMR) in animal agriculture has gained renewed prominence in the UK and international policy and practice in response to growing concern about the impact of AMR infections on human and animal health. This article adopts a more‐than‐human approach inspired by assemblage and biopolitical thinking to explore how diverse actors work to assemble a regime of governance in animal agriculture through their efforts to tackle AMR. How agricultural animals are represented and positioned in this process, and the consequences of these efforts for broader agricultural animal–human relation in UK animal agriculture is also a concern. Qualitative, empirical material is produced from documents published by government, industry organisations, NGOs and retailers. We highlight the negotiated contingencies of actions on AMR in UK animal agriculture and reflect on the limited extent to which they constitute a new front in the regulation of agricultural animals. [ABSTRACT FROM AUTHOR]

Background: Pathologic fracture of the long bones is a common complication of bone metastases. Intramedullary nail stabilization can be used prophylactically (for impending fractures) or therapeutically (for completed fractures) to preserve mobility and quality of life. However, local disease progression may occur after such treatment, and there is concern that surgical instrumentation and the intramedullary nail itself may seed tumor cells along the intramedullary tract, ultimately leading to loss of structural integrity of the construct. Identifying factors associated with local disease progression after intramedullary nail stabilization would help surgeons predict which patients may benefit from alternative surgical strategies.Questions/purposes: (1) Among patients who underwent intramedullary nail stabilization for impending or completed pathologic fractures of the long bones, what is the risk of local progression, including progression of the existing lesion and development of a new lesion around the nail? (2) Among patients who experience local progression, what proportion undergo reoperation? (3) What patient characteristics and treatment factors are associated with postoperative local progression? (4) What is the difference in survival rates between patients who experienced local progression and those with stable local disease?Methods: Between January 2013 and December 2019, 177 patients at our institution were treated with an intramedullary nail for an impending or completed pathologic fracture. We excluded patients who did not have a pathologic diagnosis of metastasis before fixation, who were younger than 18 years of age, who presented with a primary soft tissue mass that eroded into bone, and who experienced nonunion from radiation osteitis or an avulsion fracture rather than from metastasis. Overall, 122 patients met the criteria for our study. Three fellowship-trained orthopaedic oncology surgeons involved in the care of these patients treated an impending or pathologic fracture with an intramedullary nail when a long bone lesion either fractured or was deemed to be of at least 35% risk of fracture within 3 months, and in patients with an anticipated duration of overall survival of at least 6 weeks (fractured) or 3 months (impending) to yield palliative benefit during their lifetime. The most common primary malignancy was multiple myeloma (25% [31 of 122]), followed by lung carcinoma (16% [20 of 122]), breast carcinoma (15% [18 of 122]), and renal cell carcinoma (12% [15 of 122]). The most commonly involved bone was the femur (68% [83 of 122]), followed by the humerus (27% [33 of 122]) and the tibia (5% [6 of 122]). A competing risk analysis was used to determine the risk of progression in our patients at 1 month, 3 months, 6 months, and 12 months after surgery. A proportion of patients who ultimately underwent reoperation due to progression was calculated. A univariate analysis was performed to determine whether lesion progression was associated with various factors, including the age and sex of the patient, use of adjuvant therapies (radiation therapy at the site of the lesion, systemic therapy, and antiresorptive therapy), histologic tumor type, location of the lesion, and fracture type (impending or complete). Patient survival was assessed with a Kaplan-Meier curve. A p value < 0.05 was considered significant.Results: The cumulative incidence of local tumor progression (with death as a competing risk) at 1 month, 3 months, 6 months, and 12 months after surgery was 1.9% (95% confidence interval 0.3% to 6.1%), 2.9% (95% CI 0.8% to 7.5%), 3.9% (95% CI 1.3% to 8.9%), and 4.9% (95% CI 1.8% to 10.3%), respectively. Of 122 patients, 6% (7) had disease progression around the intramedullary nail and 0.8% (1) had new lesions at the end of the intramedullary nail. Two percent (3 of 122) of patients ultimately underwent reoperation because of local progression. The only factors associated with progression were a primary tumor of renal cell carcinoma (odds ratio 5.1 [95% CI 0.69 to 29]; p = 0.03) and patient age (difference in mean age 7.7 years [95% CI 1.2 to 14]; p = 0.02). We found no associations between local disease progression and the presence of visceral metastases, other skeletal metastases, radiation therapy, systemic therapy, use of bisphosphonate or receptor activator of nuclear factor kappa-B ligand inhibitor, type of fracture, or the direction of nail insertion. There was no difference in survivorship curves between those with disease progression and those with stable local disease (= 0.36; p = 0.54).Conclusion: Our analysis suggests that for this population of patients with metastatic bone disease who have a fracture or impeding fracture and an anticipated survival of at least 6 weeks (completed fracture) or 3 months (impending fracture), the risk of experiencing local progression of tumor growth and reoperations after intramedullary nail stabilization seems to be low. Lesion progression was not associated with the duration of survival, although this conclusion is limited by the small number of patients in the current study and the competing risks of survival and local progression. Based on our data, patients who present with renal cell carcinoma should be cautioned against undergoing intramedullary nailing because of the risk of postoperative lesion progression.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

We present a unique case of an aggressive scapular osteoblastoma that produced β-hCG as a paraneoplastic manifestation in a 20-year-old woman. Serum β-hCG was found to be elevated during presurgical workup and consequently delayed surgical resection of the increasingly painful tumor because of suspected pregnancy. The paraneoplastic production of β-hCG was later proven by positive immunohistochemical stain of β-hCG in a curettage specimen and normalization of β-hCG levels after surgical resection of the aggressive osteoblastoma. Production of beta-human chorionic gonadotropin (β-hCG) has been reported in several carcinomas and sarcomas but, to our knowledge, it has not been reported in osteoblastoma in the English-language literature. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to characterize and evaluate the clinical significance of volume changes of soft tissue sarcomas during radiation therapy (RT), prior to definitive surgical resection. Materials and Methods: Patients with extremity or pelvis soft tissue sarcomas treated at our institution from 2013 to 2016 with RT prior to resection were identified retrospectively. Tumor volumes were measured using cone-beam computed tomography obtained daily during RT. Linear regression evaluated the linearity of volume changes. Kruskal-Wallis tests, Mann-Whitney U tests, and linear regression evaluated predictors of volume change. Logistic and Cox regression evaluated volume change as a predictor of resection margin status, histologic treatment response, and tumor recurrence. Results: Thirty-three patients were evaluated. Twenty-nine tumors were high grade. Prior to RT, median tumor volume was 189 mL (range, 7.2 to 4,885 mL). Sixteen tumors demonstrated significant linear volume changes during RT. Of these, 5 tumors increased and 11 decreased in volume. Myxoid liposarcoma (n = 5, 15%) predicted decreasing tumor volume (p = 0.0002). Sequential chemoradiation (n = 4, 12%) predicted increasing tumor volume (p = 0.008) and corresponded to longer times from diagnosis to RT (p = 0.01). Resection margins were positive in three cases. Five patients experienced local recurrence, and 7 experienced distant recurrence, at median 8.9 and 6.9 months post-resection, respectively. Volume changes did not predict resection margin status, local recurrence, or distant recurrence. Conclusion: Volume changes of pelvis and extremity soft tissue sarcomas followed linear trends during RT. Volume changes reflected histologic subtype and treatment characteristics but did not predict margin status or recurrence after resection. [ABSTRACT FROM AUTHOR]

This paper presents the preliminary findings of an empirical study into a specific and novel form of contemporary consumption: "yellow‐sticker shopping." This type of consumption involves the active targeting for purchase of food products that have been reduced in price because they are approaching their expiry date. Given the complexities of food provisioning in austerity Britain, that include both non‐conventional sites like markets and food banks as well as conventional "discounters" and high street supermarkets, the analysis reveals how this form of food provisioning goes far beyond the "cost‐saving" accounts that might be expected. The research uses autoethnographic material in the form of vignette, constructed around research conducted in the North of England, together with analysis of an online discussion forum. Data are thematically analysed using literature on shopping and supermarkets and then organised according to the three dimensions of social practice: materials, competences and meanings. The paper makes three key contributions in relation to the practice of yellow‐sticker shopping. First, that it has distinct spatial and temporal qualities and the role played by the space of the supermarket and its associated fixtures and technologies is important. Second, that the uncertain supply of yellow‐sticker goods results in unpredictability. Successful shopping is celebrated and characterised in ways other than the drudgery often associated with the weekly shop. Third, it reveals an assemblage of competences, skills and knowledge not only in relation to grocery shopping but that take place in the home, around food, its storage and preparation and cooking and recipe knowledge. The paper concludes by outlining further planned research associated with the practice of yellow‐sticker shopping that will contribute to ongoing study into the alternative modes of food provisioning and their spatialities that are characteristic of life in contemporary Britain. [ABSTRACT FROM AUTHOR]

This article explores a form of knowledge politics played out within and between universities and research institutes as sites of certified disciplinary expertise in the agro‐food domain. It investigates the openness of this domain to the expertise of the agro‐food social sciences particularly when challenge‐led research programmes require collaboration across disciplines. A case study is provided by the multi‐discipline field of food security research in the UK involving interviews with key stakeholders. The article examines how this research fieldfield's disciplinary diversity is understood is understood by key stakeholders. Interview data are analysed thematically in terms of the current and potential contribution of social science disciplines, the different ways in which stakeholders imagine social science research, and whether social scientists themselves recognise and align with these different imaginaries. The article concludes by arguing that the field of food security research in the UK is open only selectively to agro‐food social science knowledges and that this is likely to have negative implications for addressing the challenges of food security. Further, if the promise of collaborative working between disciplines in agro‐food research fields is to be made good then the emphasis of agro‐food knowledge politics scholarship and the governance of knowledge‐making needs to change. [ABSTRACT FROM AUTHOR]

Abstract: This article addresses UK society's relationship with meat and specifically explores the extent to which a process of ‘de‐meatification’ is underway in this context and one of the mechanisms involved. It does so through analysis of reporting of the Meat Free Mondays (MFM) campaign in the national and regional British print news media. MFM offers a convenient yet powerful vehicle for trying to understand shifting meanings of meat not least because it directly challenges, and generates debate about the dominant – meat based – diet. The article concludes by arguing that a shift is taking place in the status of meat within UK society with the print news media acting as a mechanism that is working in support of de‐meatification. However, these conclusions are qualified in a number of important ways, including the anthropocentrism of the (de)meatification debate, its geographical variability and its weakly politicised character. [ABSTRACT FROM AUTHOR]

Background: Reported rates of the incidence of lymph node metastasis in soft tissue sarcoma vary considerably. Many are based on single-institution series and small patient populations. Certain sarcoma subtypes, including synovial sarcoma, have been associated with a higher risk of lymph node involvement. Most single centers have insufficient numbers of patients to assess lymph node metastasis accurately, but larger national databases may allow a more accurate estimation.Questions/purposes: We queried a large national database and asked the following questions: (1) What proportion of patients with soft tissue sarcoma have lymph node metastasis and distant metastasis? (2) What histologic subtypes are associated with increased risk of nodal metastasis? (3) What is the impact of lymph node metastases and histologic subtype on survival? (4) Does lymph node excision improve survival of patients with soft tissue sarcoma?Methods: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program is a national database that covers a geographic cross-section representing approximately 28% of the US population across demographic groups. Using the SEER database, we identified 15,525 adults diagnosed with histologically confirmed soft tissue sarcoma from 2004 to 2013. Proportions of patients with lymph node or distant metastases were calculated using descriptive statistics. Overall survival was computed using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazard regression to calculate the association of lymph node metastasis with overall survival while controlling for patient age, sex, race, tumor size, and tumor location.Results: A total of 820 of 15,525 patients had lymph node metastasis at the time of diagnosis, yielding an overall proportion of 5.3% (95% confidence interval [CI], 4.9%-5.6%). Histologic subtypes that most frequently developed nodal metastasis were rhabdomyosarcoma, clear cell sarcoma, epithelioid sarcoma, and myxoid/round cell liposarcoma. Despite frequent reports regarding its association with lymph node metastasis, the proportion of patients with lymph node metastasis among 885 patients with synovial sarcoma (4.2%) was not different from the proportion with nodal metastasis in the overall soft tissue sarcoma population. For all soft tissue sarcomas, distant metastatic disease was present at diagnosis in 1869 (12%) patients (95% CI, 11.5%-12.6%). After controlling for relevant covariates, lymph node metastasis was associated with poorer overall survival (hazard ratio [HR], 1.34; 95% CI, 1.22-1.48; p < 0.001) as was distant metastasis (HR, 2.87; 95% CI, 2.66-3.09; p < 0.001). When comparing the subgroup of patients with positive lymph nodes, lymphadenectomy in conjunction with local excision/limb salvage was associated with the highest overall 5-year survival (HR, 0.46; 95% CI, 0.31-0.67; p < 0.001).Conclusions: In clarifying the overall proportion of patients with soft tissue sarcoma with nodal metastases, the current study indicates that lymph node metastases occur at a higher proportion than previous studies have suggested and that synovial sarcoma is not associated with a higher risk of lymphatic spread compared with soft tissue sarcoma overall. Patients with lymph node metastases are associated with poorer survival than those without metastases. Further investigation is needed to clarify the apparent improved overall survival after lymphadenectomy in the setting of nodal metastasis from soft tissue sarcoma.Level Of Evidence: Level II, prognostic study. [ABSTRACT FROM AUTHOR]

Background: To assess the acquisition speed, lesion conspicuity, and inter-observer agreement associated with volumetric T(1)-weighted MR sequences with isotropic resolution for detecting recurrent soft-tissue sarcoma (STS).Methods: Fifteen subjects with histologically proven recurrent STS underwent MRI, including axial and coronal T(1)-weighted spin echo (T(1)-WSE) (5-mm slice thickness) and coronal 3D volumetric T(1)-weighted (fat-suppressed, volume-interpolated, breath-hold examination; repetition time/echo time, 3.7/1.4 ms; flip angle, 9.5°; 1-mm slice thickness) sequences before and after intravenous contrast administration. Subtraction imaging and multiplanar reformations (MPRs) were performed. Acquisition times for T(1)-WSE in two planes and 3D sequences were reported. Two radiologists reviewed images for quality (>50 % artifacts, 25-50 % artifacts, <25 % artifacts, and no substantial artifacts), lesion conspicuity, contrast-to-noise ratio (CNR(muscle)), recurrence size, and recurrence-to-joint distance. Descriptive and intraclass correlation (ICC) statistics are given.Results: Mean acquisition times were significantly less for 3D imaging compared with 2-plane T(1)-WSE (183.6 vs 342.6 s; P = 0.012). Image quality was rated as having no substantial artifacts in 13/15 and <25 % artifacts in 2/15. Lesion conspicuity was significantly improved for subtracted versus unsubtracted images (CNR(muscle), 100 ± 138 vs 181 ± 199; P = 0.05). Mean recurrent lesion size was 2.5 cm (range, 0.7-5.7 cm), and measurements on 3D sequences offered excellent interobserver agreement (ICC, 0.98 for lesion size and 0.96 for recurrence-to-joint distance with MPR views).Conclusion: Three-dimensional volumetric sequences offer faster acquisition times, higher spatial resolution, and MPR capability compared with 2D T(1)-WSE for postcontrast imaging. Subtraction imaging provides higher lesion conspicuity for detecting recurrent STS in skeletal muscle, with excellent interobserver agreement between readers. [ABSTRACT FROM AUTHOR]

The article presents a case study of 91 year old man who was suffering from pain, tenderness, and swelling in the right foot and increased difficulty in walking. He experienced maceration in the second and third web spaces of his foot. He was recommended to use rolling walker for support while walking due to pain. The article discusses regarding dedifferentiated chondrosarcoma of toe phalanx associated with dismal prognosis.

This paper focuses on the production of aesthetic ‘truths’ in UK livestock breeding, drawing on detailed qualitative research with breeders and breed societies. It extends emerging interest in the aesthetic in human geographical research, examining how aesthetic judgements about non-human animals depend, in part, on the agency of the animal and their inter-subjective relations with humans in specific places. Aesthetic evaluation further produces implicit judgements about animals' ethical considerability, at the same time obscuring the effects of such judgements on their framing and treatment. Aesthetic evaluation is thus related to sets of material and ethical interests. The paper develops a more-than-human reading of Foucault's biopower, which explores how truths about visual evaluations of animals become established. Two empirical perspectives explore, first, a ‘relational practical aesthetic’ for evaluating beef cattle and sheep, exploring the implications of the aesthetic framing of specific animals and, second, the tensions involved in looking at animals when different aesthetic truths conflict and when traditions of aesthetic evaluation encounter genetic modes of evaluation. The paper concludes by discussing the ethical implications of ongoing transformations of evaluative modes in livestock breeding, suggesting that shifts away from inter-subjective modes of aesthetic evaluation further diminish the ethical status of animals. [ABSTRACT FROM AUTHOR]

Abstract: The prevalence of antimicrobial resistant (AMR) bacteria is increasing worldwide and remains a significant medical challenge which may lead to antimicrobial redundancy. The contribution of hospital effluent to the prevalence of resistance in wastewater treatment plant (WWTP) effluents is not fully understood. AMR bacteria contained in hospital effluent may be released into the aquatic and soil environments after WWTP processing. Hence, the objective of this study is to identify the extent hospital effluent contributes to contamination of these environments by comparing two WWTPs, one which receives hospital effluent and one which does not. AMR Escherichia coli were monitored in the two WWTPs. A model was developed using these monitored values to predict the effect of hospital effluent within a WWTP. The model predicted levels of AMR E. coli in the aquatic environment and potential bather exposure to AMR E. coli. The model results were highly variable. WWTP influent containing hospital effluent had a higher mean percentage of AMR E. coli; although, there appeared to be no within treatment plant effect on the prevalence of AMR E. coli. Examination of WWTP sludge showed a similar variation. There appeared to be no consistent effect from the presence of hospital effluent. The human exposure assessment model predicted swimmer intake of AMR E. coli between 6 and 193CFU/100ml sea water. It appears that hospital effluent is not the main contributing factor behind the development and persistence of AMR E. coli within WWTPs, although resistance may be too well-developed to identify an influence from hospital effluent. Mitigation needs to focus on the removal of already present resistant bacteria but for new or hospital specific antimicrobials focus needs to be on their limited release within effluents or separate treatment. [Copyright &y& Elsevier]

The extent hospital effluent contributes to antimicrobial presence in the environment and its impact on resistance dissemination remains unknown. To investigate the fate of the antimicrobial ciprofloxacin in hospital effluent a Monte Carlo simulation model was developed to model levels from hospital use to wastewater treatment plant (WWTP) effluent release, in addition to modeling resistance formation potential, hazard quotient (HQ) and swimmer exposure. The mean predicted concentration (PC) of ciprofloxacin in hospital effluent, urban effluent, WWTP effluent, sludge, soil and sea water was 579, 6.06, 2.59, 3.48, 0.006 and 0.15 mg/m3, respectively. A parallel surveillance study confirmed levels of ciprofloxacin above or below the limit of detection. The model predicted levels would never exceed the ECOSAR toxicity value. The model predicted a 98% probability of ciprofloxacin exhibiting a HQ > 1 (low toxicity concern). The mean ciprofloxacin PC in WWTP effluent was less than the minimum inhibitory concentration (MIC). The probability of conditions in WWTP effluent being favorable for resistance at 20% and 80% of the MIC was 3% and 72%, respectively. In all instances, when the MIC was bound, the probability for resistance formation within soil and sea water was < 1%. The probability of a swimmer being exposed to a level of ciprofloxacin greater than the acceptable daily intake was negligible. The study concluded that release of hospital effluent into the environment may lead to concentrations of ciprofloxacin which are of low toxicity concern but may be conducive to resistance formation and allow for the dissemination of resistance. [ABSTRACT FROM AUTHOR]

Background: Compliant, self-adjusting compression technology is a novel approach for durable prosthetic fixation of the knee. However, the long-term survival of these constructs is unknown. Questions/purposes: We therefore determined the survival of the Compress prosthesis (Biomet Inc, Warsaw, IN, USA) at 5 and 10 actuarial years and identified the failure modes for this form of prosthetic fixation. Methods: We retrospectively reviewed clinical and radiographic records for all 82 patients who underwent Compress knee arthroplasty from 1998 to 2008, as well as one patient who received the device elsewhere but was followed at our institution. Prosthesis survivorship and modes of failure were determined. Followup was for a minimum of 12 months or until implant removal (median, 43 months; range, 6-131 months); 28 patients were followed for more than 5 years. Results: We found a survivorship of 85% at 5 years and 80% at 10 years. Eight patients required prosthetic revision after interface failure due to aseptic loosening alone (n = 3) or aseptic loosening with periprosthetic fracture (n = 5). Additionally, five periprosthetic bone failures occurred that did not require revision: three patients had periprosthetic bone failure without fixation compromise and two exhibited irregular prosthetic osteointegration patterns with concomitant fracture due to mechanical insufficiency. Conclusions: Compress prosthetic fixation after distal femoral tumor resection exhibits long-term survivorship. Implant failure was associated with patient nonadherence to the recommended weightbearing proscription or with bone necrosis and fracture. We conclude this is the most durable FDA-approved fixation method for distal femoral megaprostheses. Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

There is a growing scholarship on the role of the amateur, and amateur societies, in the production and circulation of weather and climate knowledge in the past. Yet relatively little attention has been paid to the actual and potential contribution of contemporary amateur meteorologists in this respect. In this paper we first examine the importance of the amateur historically in the production of local weather knowledge and also in the emergence of professional meteorology. Drawing on semi-structured interviews with members of one contemporary UK based amateur meteorological organisation-the Climatological Observers Link (COL)-we then investigate the nature and extent of contemporary amateur meteorologists' contributions to a wide range of different 'publics' today, which include both popular and professional communities. Finally, we interrogate our interview data to identify whether COL members themselves recognise a wider role for their expertise at a time of increasing popular and scientific interest in weather and climate and in an era when the inclusion of non-certified experts in policy decision making processes is being advocated. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss various reports within the issue on topics including the effects of the severe winter in Cwm Tywi, Wales in 1946 and 1947 to its inhabitants, climate change as an environmental discourse, and the role of space and place in understanding climate change.

Abstract: The utilisation of oligosaccharides by oral microorganisms and intestinal enzymes are important factors in determining their effectiveness as alternative sweeteners. In this study, classes of naturally occurring sugars were assessed using in vitro models for oral and intestinal digestibility, in order to test the influence of chemical structure on functional properties. Amongst the classes of sucrose isomers, α-glucobioses, β-glucobioses and sucrose-based oligosaccharides, structures were identified that were not utilised by the common oral bacterium Streptococcus mutans, and would therefore contribute to the non-cariogenic potential of a sweetener. Analysis of the rate and products of digestion by a rat glucosidase mixture was used to determine the relative intestinal digestibility. The results showed that oligosaccharides containing a (1→6)-β-Glc group, including gentiobiose and gentiobiitol, together with melezitose, a sucrose-derived oligosaccharide containing a α-Glc-(1→3)-Fru moiety were resistant to digestion by both S. mutans and mammalian intestinal enzymes, highlighting their potential as dietary sugar substitutes. [Copyright &y& Elsevier]

Although there is a growing scholarship on the history of amateur meteorology, contemporary amateur meteorology has tended to remain a largely invisible social phenomenon. Moreover, questions of female involvement and gender relations therein have tended to be overlooked. This paper seeks to address this gap by drawing on interviews with members of one of the most important amateur meteorological networks in the UK—the Climatological Observers Link. The research identifies a predominantly male bias within amateur meteorology in the UK, offers insight into why and how this bias has emerged and explores the implications of this bias for gender politics in the home. It also considers the way in which, as a pursuit that is very much situated within the domestic sphere, amateur meteorology complicates traditional framings of the home as a female realm and contributes to a domestic masculinity. [ABSTRACT FROM AUTHOR]

Cattle and sheep breeders in the UK and elsewhere increasingly draw on genetic techniques in order to make breeding decisions. Many breeders support such techniques, while others argue against them for a variety of reasons, including their preference for the 'traditions' of visual-based and pedigree-based selections. Meanwhile, even for those institutions and breeders who promote genetic techniques, the outcomes are not always as predicted. We build on our recent use of Foucault's discussions of biopower to examine the effects of the introduction of genetic techniques in UK livestock breeding in order to begin to explore the diffuse and capillary nature of resistance within relations of biopower. We focus specifically on how resistance and contestation can be understood through the joint lenses of biopower and an understanding of livestock breeding as knowledge-practices enacted within heterogeneous biosocial collectivities. In some instances these collectivities coalesce around shared endeavour, such as increasing the valency of genetic evaluation within livestock breeding. Yet such mixed collectivities also open up opportunities for counter-conduct: heterogeneous resistances to and contestations of genetic evaluation as something represented as progressive and inevitable. We focus on exploring such modes of resistance using detailed empirical research with livestock breeders and breeding institutions. We demonstrate how in different and specific ways geneticisation becomes problematised, and is contested and made more complex, through the knowledge-practices of breeders, the bodies of animals, and the complex relationships between different institutions in livestock breeding and rearing. [ABSTRACT FROM AUTHOR]

Drawing on data from a research project that focused on the relationship between the biodiversity of grazing and food quality, this article explores the ecological dimensions of alternative food networks in the UK through the concept of 'styles of ecological engagement'. Context is provided by briefly reviewing two contrasting ways of envisaging the relationship between ecology, food and rural development in policy debates. A qualitative analysis of semi-structured interviews with actors at the centre of 38 alternative food networks and of associated promotional materials enables the identification of five styles of ecological engagement: ecological conserving, ecological harmonising, ecological breed enthusing, ecological localising and ecological re-cognising. The article argues that identification and discussion of these styles of ecological engagement is not only helpful in understanding the ecological heterogeneity of alternative food networks but also signals the ways in which their ecological benefits and contribution to rural development might be sustained and enhanced. [ABSTRACT FROM AUTHOR]

This paper explores the environmental knowledge of small-scale rural landholders and comments on the implications of this for environmental policy. The paper draws on conceptualisations of knowledge as ‘know what’, ‘know why’, ‘know how’ and ‘know who’, recognises a distinction between tacit and codified environmental knowledges and highlights the need to consider the politics of knowledge surrounding environmental issues. Both quantitative and qualitative data are reported, and are derived from structured interviews with 30 small-scale landholders who were participants in a nature and landscape conservation initiative – the Landscape Heritage Scheme – within South Devon, England. These data are used to explore the place of environmental concerns within the land management objectives of respondents; the nature and extent of their environmental knowledge; how a range of factors alongside their environmental knowledge shaped the environmental practices of respondents; and the politics of knowledge associated with the Landscape Heritage Scheme. The paper suggests that small-scale landholders should be of interest to environmental policy, prioritising environmental objectives in their land management, being relatively knowledgeable about the environment and highly responsive to environmental advice and financial incentives that support environmental management. A case is made for developing research in this area, given ongoing processes of rural demographic change and the rising importance within this of an increasingly diverse landholding population. [ABSTRACT FROM AUTHOR]

This article explores the interrelationship between particular "natural" spaces and the production of middle- and long-distance performance running bodies. It argues that running bodies and nature are actively co-produced, thus blurring the commonly made distinction between the "social" and the "natural". In doing so, the article extends the geography of sports literature by adopting a "post-constructivist" perspective on nature as elucidated in Tim Ingold's concepts of "dwelling" and "taskscape". This illuminates the (re)production of sporting bodies through the materiality of nature and in turn contributes to research on embodiment within sports studies that highlights the importance of space and the natural environment. The article draws on ethnographic material and textual sources to illuminate the running taskscape associated with the production of performance running bodies and highlights how three forms and functions of nature are co-produced through this mode of dwelling. [ABSTRACT FROM AUTHOR]

Genetic techniques have become increasingly prevalent in livestock breeding, associated with new types of knowledge-practice and changes in the institutional and geographical relationships related to animal husbandry. This paper examines the value of Foucault’s concept of ‘biopower’ to theorising livestock breeding and the implications of the rise of genetic knowledge-practices in agriculture, developing the concept to apply to nonhuman animals and to situations where humans and nonhuman animals are co-constituted through particular knowledge-practices and corporeal meetings. It focuses on the idea of ‘population’ as a central component of biopower, and relates this to conceptualisations of biosocial collectivity. Reacting to the inherent humanism of Foucault’s outlining of biopower, the paper argues for its relevance in relation to nonhuman populations, and for heterogeneous conceptualisations of biosocial collectivity. Drawing on research with UK beef cattle and sheep breed societies, the paper explores how, in practice, populations are constructed in relation to the production of particular sorts of truths concerning, and particular modes of intervention in, the lives of nonhuman animals. It explores how heterogeneous biosocial collectivities are constituted around these interventions. The emergence of genetic techniques is shown to transform the processes constituting populations and heterogeneous biosocial collectivities, and this is discussed in terms of a new inflection of agricultural biopower associated with novel interventions in the lives of livestock animals. [ABSTRACT FROM AUTHOR]

This paper presents an agenda for research into the geographies of UK livestock agriculture as these are being reconfigured through the increasing intervention of genetic techniques and technologies. After discussing three particular techniques, four areas of research are identified. The first three relate to different spaces and scales at which the effects of genetic techniques can be examined: the animal body and animal-human relationships; the farm and other rural spaces; and the national and international networks of genetic knowledge-practices relating to livestock. The fourth area outlines an agenda for engaging with Foucault's notion of biopower as a possible means of gaining a theoretical purchase on three key issues which span these three scales: knowledge, power and life. In its reflections on the wider implications of the proposed research the paper aims to speak to a number of audiences within and beyond the discipline. [ABSTRACT FROM AUTHOR]

Simple Summary: Multiple myeloma is a plasma cell cancer involving bone destruction and is considered an incurable disease despite significant improvements in therapeutic strategies. During myeloma progression, over 90% of patients develop a bone disease that causes patient injury and death. There are limited animal models available to demonstrate multiple myeloma bone disease (MMBD). The current study identifies and validates the newly developed MMBD models with uniformity of tumor burden and severe bone lesions. This model will help study the biology of MMBD and serve as a valuable tool for screening therapeutic candidates by monitoring their response to disease progression. Multiple myeloma (MM) is a plasma cell malignancy that causes an accumulation of terminally differentiated monoclonal plasma cells in the bone marrow, accompanied by multiple myeloma bone disease (MMBD). MM animal models have been developed and enable to interrogate the mechanism of MM tumorigenesis. However, these models demonstrate little or no evidence of MMBD. We try to establish the MMBD model with severe bone lesions and easily accessible MM progression. 1 × 106 luciferase-expressing 5TGM1 cells were injected into 8–12 week-old NOD SCID gamma mouse (NSG) and C57BL/KaLwRij mouse via the tail vein. Myeloma progression was assessed weekly via in vivo bioluminescence (BL) imaging using IVIS-200. The spine and femur/tibia were extracted and scanned by the micro-computer tomography for bone histo-morphometric analyses at the postmortem. The median survivals were 56 days in NSG while 44.5 days in C57BL/KaLwRij agreed with the BL imaging results. Histomorphic and DEXA analyses demonstrated that NSG mice have severe bone resorption that occurred at the lumbar spine but no significance at the femur compared to C57BL/KaLwRij mice. Based on these, we conclude that the systemic 5TGM1 injected NSG mouse slowly progresses myeloma and develops more severe MMBD than the C57BL/KaLwRij model. [ABSTRACT FROM AUTHOR]

This article explores whether vegetarianism is congruent with the alternative food economy. Although it has been largely neglected by scholars concerned with agro-food system alternatives, there are good reasons to undertake an exploration of vegetarianism in this context, not least because of the ethical relationships that it seeks to create within the food system. Drawing on recent work by Hilary Tovey in which she applies Eyerman and Jamison's cognitive approach to social movements, the article conceptualises vegetarianism as a social movement with the potential to effect change within the food system and, ultimately (perhaps), bring about rural development benefits. The article identifies and discusses a number of tensions and contradictions within the cognitive praxis of the vegetarian movement, and between the movement's cognitive praxis and external institutions, raising questions about the congruence between vegetarianism and the alternative food economy. It also makes some suggestions about the ways in which the vegetarian movement might reclaim a place at the table of the alternative food economy and in the process make a contribution to rural development. By way of conclusion, the article identifies a number of areas for possible future empirical research, as well as suggesting that the extension of an invitation to vegetarians to sit at the table of the alternative food economy has provided an interesting opportunity to reflect upon the menu on offer. [ABSTRACT FROM AUTHOR]

In this paper, we briefly describe the mission, history, and current status of the National Science Digital Library (NSDL), and then focus on the current and near future work of the NSDL Core Integration (CI) service, including the NSDL Collection Development activity, phase two of the architecture and data model, and two new services—On Ramp and Expert Voices—that leverage acquisition and management of user-contributed contextual information about educational resources, and the ability to express complex relationships between them—made possible by the new architecture. An introduction to the NSDL is provided by the About NSDL page at http://nsdl.org/. [ABSTRACT FROM AUTHOR]

The article focuses on the use of bisphosphonates in orhtopaedic surgery. Bisphosphonates are the most clinically important class of antiresorptive agents available to treat diseases characterized by osteoclast-mediated bone resorption such as osteoporosis, Paget disease, and tumor-associated bone diseases. Currently, seven bisphosphonates have the approval of the U.S. Food and Drug Administration. The treatment of pediatric disorders such as osteogenesis imperfecta and fibrous dysplasia with bisphoshonates has gained momentum, and initial investigations have demonstrated an accepted safety profile.

Considerable academic interest now revolves around the recomposition of specific (or 'alternative') food chains based on notions of quality; territory and social embeddedness. A key to such recomposition is the marketing of 'difference' through a range of accreditation and labelling schemes. Using examples from Europe and North America, this paper examines how 'difference' is constructed by producers and other actors in the food supply chain by combining the attributes of 'product, process and place' (PPP) in a range of marketing and labelling schemes. Results indicate that it is possible to identify 'critical' and 'territorial development' rationales that influence the ways in which the three Ps are combined. An examination of the rationales and practices sustaining such labelling schemes provides insights into some of the opportunities and threats shaping the emergence of new geographies of food production and consumption in Europe and North America. [ABSTRACT FROM AUTHOR]

Within Europe and North America the integration of environmental concerns into agriculture has become a domain almost exclusively defined by public policy. In this paper it is contended that we are currently witnessing a new direction in attempts to reconcile agricultural production and environmental protection, in which the market is playing an increasingly important role. The paper takes as its focus the rapidly expanding number of what are termed ‘market-oriented initiatives for environmentally sustainable food production’ (MOIs), in which the incentive for food producers to manage the environment positively comes directly through the market. The number of MOIs, in both Europe and North America, has proliferated recently, although some have been established for many years. However, both older and newer forms of these MOIs appear to be the focus of a new rural development, food quality, and sustainable farming agenda. In an attempt to make a contribution to this emergent debate, this paper sets out to address the extent to which these MOIs are capable of contributing to the development of more environmentally sustainable food production. In this paper we consider the drivers of this new approach, review the various types of MOI that are emerging in both Europe and North America, and examine the different approaches to environmental management that MOIs adopt. The paper also offers a reflection upon the potential contribution of MOIs to the delivery of environmental goods in food production and the implications of this for public sector approaches. [ABSTRACT FROM AUTHOR]

Abstract Within society, farm animal welfare is moving up the policy and moral agenda as many of the industrial processes associated with animal farming are now being called into question. In the academy, there is growing intellectual interest in the relationship of humanity to animality and the porosity or otherwise of the biologically and socially constructed boundaries between them. This paper uses the farm animal welfare debate to explore changes in society animal relations by looking in turn at the farm, at farm animals and at the notion of farm animal welfare itself. The paper explores the paradox that for as long as society eats and kills animals for food, we are necessarily bound up in a persistent modernist and essentialist conceptualisation of animals and nature. However, alternative approaches are investigated as part of what might be described as a more postmodern approach to animalian difference. [ABSTRACT FROM AUTHOR]

Agriculture is a key land user implicated in the causes of, and solutions to, the problem of biodiversity decline. The development, in the late 1990s, of farm biodiversity action plans (farm BAPs) represents an important step towards achieving greater farmer involvement in biodiversity and is the first specific attempt to devise a practical mechanism for meeting biodiversity targets at the farm level. In this paper the processes surrounding the design and implementation of farm BAPs are used to explore how farmers are responding to the biodiversity issue and to highlight challenges and opportunities being faced by the organizations delivering biodiversity to the farming community. It describes the formulation and operation of farm BAPs, and then moves on to present two conceptual domains, governance and ecological modernization, which provide a framework for interpreting the emergence of farm BAPs. Following a brief elaboration of methodology, the paper presents and discusses selected findings from empirical research into farm BAPs across the UK. [ABSTRACT FROM AUTHOR]

Drawing upon the 'Farmlife' pages of Farmers' Weekly, the most significant farming publication in the UK, this article assesses the ways in which gender identities in farming are represented in text and images. Lead articles from 1976 and 1996 issues of 'Farmlife' are taken as the research focus to determine how representations have altered in line with restructuring of the agricultural industry. Reference is made to Connell's notions of hegemonic masculinity and emphasised femininity to inform the analysis about the ways in which these gender identities are (re)produced through the British farming media. A simple typology is derived from the articles, which assists in revealing a remarkable degree of consistency in the portrayal of gender identities over time. Case studies reveal that hegemonic masculinity and emphasised femininity are perpetuated through the farming media, but in increasingly subtle and fragmented ways. The limitations of Connell's conceptualisation are revealed, particularly in its ability to accommodate multiple constructions of femininity. Suggestions are made for research that investigates the consumers of these media products. [ABSTRACT FROM AUTHOR]

ABSTRACT Established largely by private sector institutions in the food supply system, quality assurance schemes (QASs) have recently become significant as means of addressing consumer concerns about food production and to help improve the competitiveness of food producers. The environmental standards of QASs offer a new opportunity for the delivery of environmental benefits in food production. The paper examines this potential contribution by considering the place of environmental concerns within the design and operation of QASs as a whole and through preliminary analysis of the environmental standards within a selection of schemes. This initial investigation suggests that QASs are unlikely to produce the environmental outcomes characteristic of public sector agri-environmental schemes, but could make a contribution to raising the baseline of good environmental practice in agriculture. The complementary relationship between QASs and other agri-environmental delivery mechanisms is considered in the conclusion. [ABSTRACT FROM AUTHOR]

Abstract: Monitoring the serum hepatitis B viral DNA levels with sensitive realtime PCR assays is strongly recommended for the management of patients with chronic HBV infection. This study compares the performance of two realtime HBV quantitative PCR assays with samples from chronic HBeAg(+) and HBeAg(−) patients. [Copyright &y& Elsevier]

Percent necrosis (PN) following chemotherapy is a prognostic factor for survival in osteosarcoma. Pathologists estimate PN by calculating tumor viability over an average of whole‐slide images (WSIs). This non‐standardized, labor‐intensive process requires specialized training and has high interobserver variability. Therefore, we aimed to develop a machine‐learning model capable of calculating PN in osteosarcoma with similar accuracy to that of a musculoskeletal pathologist. In this proof‐of‐concept study, we retrospectively obtained six WSIs from two patients with conventional osteosarcomas. A weakly supervised learning model was trained by using coarse and incomplete annotations of viable tumor, necrotic tumor, and nontumor tissue in WSIs. Weakly supervised learning refers to processes capable of creating predictive models on the basis of partially and imprecisely annotated data. Once "trained," the model segmented areas of tissue and determined PN of the same six WSIs. To assess model fidelity, the pathologist also estimated PN of each WSI, and we compared the estimates using Pearson's correlation and mean absolute error (MAE). MAE was 15% over the six samples, and 6.4% when an outlier was removed, for which the model inaccurately labeled cartilaginous tissue. The model and pathologist estimates were strongly, positively correlated (r = 0.85). Thus, we created and trained a weakly supervised machine learning model to segment viable tumor, necrotic tumor, and nontumor and to calculate PN with accuracy similar to that of a musculoskeletal pathologist. We expect improvement can be achieved by annotating cartilaginous and other mesenchymal tissue for better representation of the histological heterogeneity in osteosarcoma. [ABSTRACT FROM AUTHOR]

The anatomic extent of a pelvic bone tumor and the need for reconstruction dictate the type of pelvic resection (limb salvage pelvic resection or amputation). If a pelvic bone tumor resection involves two or more critical anatomic structures (the sciatic nerve, femoral neurovascular bundle or the hip joint), then reasonable functional recovery after limb salvage is less likely and amputation should be considered. Both limb salvage and amputation approaches to the pelvis are technically arduous surgeries with significant associated morbidity and complications. As such, imaging plays an important role in the post-operative management of patients who have undergone pelvic bone tumor resection. In this article, we will review optimal imaging techniques as well as the expected post-operative appearance after pelvic bone tumor resection and important complications including infection, tumor recurrence, and complications related to complex soft tissue and osseous reconstruction. [ABSTRACT FROM AUTHOR]

Chondromyxoid fibroma is a rare, benign tumor of the bone with excellent prognosis but a high rate of recurrence. We report a patient presenting with pain and a history of chondromyxoid fibroma of the distal left femur previously treated with multiple prior curettage and bone graft procedures. Magnetic resonance imaging and histopathology indicated a recurrence of tumor. Due to the small size of the tumor recurrence and challenges associated with prior open surgery, the patient underwent cryoablation of the lesion with computed tomography guidance. Follow-up 18 months later indicated a resolution of pain and improvement on magnetic resonance imaging, and no concerns after 20 months. To our knowledge, this is the first reported case of chondromyxoid fibroma treated with cryoablation. This case suggests cryoablation could be considered in the setting of recurrent chondromyxoid fibroma for local tumor control. [ABSTRACT FROM AUTHOR]

Background: Stratification of the fracture risk is an important treatment component for patients with multiple myeloma, which is associated with up to an 80% risk of pathologic fracture. The Mirels score, which is commonly used to estimate the fracture risk for patients with osseous lesions, was evaluated in a cohort in which fewer than 15% of lesions were caused by multiple myeloma. The behavior of multiple myeloma lesions often differs from that of lesions caused by metastatic disease, and accurate risk stratification is critical for effective care. To our knowledge, the Mirels score has not been validated specifically for multiple myeloma.Questions/purposes: Our purpose was: (1) To develop a novel scoring system for the prediction of pathologic fracture in patients with long-bone lesions from multiple myeloma; and (2) to compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) area under curve (AUC) between the novel scoring system and the Mirels system.Methods: Between 2003 and 2017, 763 patients at one center with the diagnosis of multiple myeloma were reviewed, of whom 174 presented with long-bone disease involvement. Of those, 5% (nine of 174) were missing data or radiographs at a minimum of 1 year and had not reached an endpoint (fracture or surgery) before that time and were therefore excluded. Many patients have more than one lesion; consequently, we used the largest lesion in each patient, resulting in 163 lesions in as many patients. Ten percent (16 of 163) of these patients eventually developed a fracture and 4% (six of 163) underwent prophylactic stabilization (excluded from analysis because of outcome uncertainty). During the study period, prophylactic stabilization was performed at the discretion of the orthopaedic oncologist. Fifty-one percent (83 of 163) of patients were female, and the mean (± SD) age was 60 ± 10 years at radiographic lesion identification. All lesions were characterized before determining whether the patient underwent pathologic fracture. We identified variables associated with pathologic fracture on univariate analysis. Variables independently significant on logistic regression analysis were used to generate scoring algorithms at varying weights and scoring cutoffs for comparison via ROC curves. We then selected a novel score based on ROC performance, and compared the sensitivity, specificity, PPV, and NPV of that scoring system to that of Mirels score. ROC AUCs were compared after bootstrapping 100,000 iterations. Alpha was set at 0.05.Results: After controlling for potential confounders, such as age, sex, and duration of myeloma diagnosis, we found the following factors were independently associated with the occurrence of pathologic fracture: larger lesion size (area, cm2) (log odds 0.17; p = 0.03), longer lesion latency (years from diagnosis to lesion identification) (log odds 0.25; p = 0.03), presence of pain (relative risk [RR] 2.9; p = 0.04), and metaphyseal location (RR 3.2, compared with epiphyseal or diaphyseal; p = 0.003). These variables were used to formulate a novel scoring system. Compared with the Mirels system, the novel system was more sensitive (69% [95% CI 61 to 76] versus 38% [95% CI 30 to 46]; p < 0.05) but not different in terms of specificity (87% [95% CI 80 to 91] versus 87% [95% CI 81 to 92]; p > 0.05), PPV (37% [95% CI 29 to 45] versus 25% [95% CI 19 to 33]; p > 0.05), NPV (96% [95% CI 91 to 99] versus 92% [95% CI 87 to 96]; p > 0.05), or AUC (0.85 [95% CI 0.74 to 0.92] versus 0.67 [95% CI 0.51 to 0.81]; p > 0.05).Conclusion: The novel scoring system was found to be more sensitive than the Mirels system for predicting pathologic fracture in our retrospective cohort of patients with multiple myeloma-related bone disease. Specificity, PPV, NPV, and ROC AUC were not different with the numbers available. Thus, the novel scoring system may serve as a more effective screening tool to determine which patients with multiple myeloma would benefit from further radiologic or orthopaedic evaluation based on a skeletal survey.Level Of Evidence: Level III, diagnostic study. [ABSTRACT FROM AUTHOR]

Pelvic bone tumors present a diagnostic and therapeutic challenge. Due to the deep anatomic location and resultant late clinical presentation, pelvic bone tumors tend to be large and located in close proximity to pelvic viscera as well as vital neurovascular structures. Operative management of pelvic bone tumors is indicated for a variety of orthopedic oncologic conditions. In general, limb-sparing pelvic resection rather than hemipelvectomy with amputation of the ipsilateral limb is considered when a functional limb can be preserved without compromising the surgical margins. There are various options for pelvic resection and reconstruction, and the selection depends on tumor histology, anatomic location, and extent. The decision regarding choice of surgical procedure and reconstruction method for a pelvic bone tumor requires a thorough knowledge of the pelvic anatomy, and careful inspection of the anatomic extent. The surgical plan must strike a balance between acceptable functional outcome and acceptable morbidity. In this review, we describe the different types of pelvic resection techniques, and the vital role preoperative imaging plays in defining the anatomic extent of a pelvic bone tumor and subsequent surgical planning. [ABSTRACT FROM AUTHOR]

A subset of clear cell chondrosarcomas may contain focal areas of low-grade conventional chondrosarcoma; however, it is rare to find foci resembling clear cell chondrosarcoma admixed with areas otherwise typical conventional chondrosarcoma. We report two patients with conventional chondrosarcoma with clear cell features occurring in the rib, one in the setting of multiple hereditary exostoses (MHE) and the other without MHE. Both patients were found to have a destructive rib mass with a soft tissue component and underwent en bloc resection. Histologic examination revealed predominantly grade 2 conventional chondrosarcomas; however, multiple foci containing large cells with pale eosinophilic to clear cytoplasm, distinct cell borders, centrally located nuclei, and conspicuous nucleoli, resembling clear cell chondrosarcoma were identified throughout the specimen. The significance of clear cell features in an otherwise typical conventional chondrosarcoma, to our knowledge, is unknown and deserves recognition. Finally, these tumors highlight the need for careful histologic examination and proper classification as unexpected findings may impact management. [ABSTRACT FROM AUTHOR]

Aneurysmal bone cysts are benign, expansile, lytic bone lesions that behave in a locally aggressive manner. Although radiography and computed tomography (CT) can detect the lesion, magnetic resonance imaging (MRI) is ideal for the demonstration of characteristic fluid-fluid levels, extent, and margins. Treatment typically consists of open surgical curettage with the addition of local adjuvants and bone grafting. Residual or recurring lesions may be treated using percutaneous cryoablation. Although CT guidance is often employed for image guidance, visualization and targeting of smaller clusters can be challenging in young children, secondary to the partially mineralized bone matrix in the immature skeleton. In such cases, the higher contrast resolution of interventional MRI affords direct visualization and targeting of small aneurysmal bone cysts, accurate monitoring of the extent of the growing ice ball beyond the lesion's margin, and avoidance of exposure to ionizing radiation. We report a case of a 5-year-old boy with recurrent or remaining aneurysmal bone cysts of the scapula after surgical excision and embolization, which were successfully treated using MRI-guided cryoablation. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to assess the incidence of and risk factors for thromboembolic events—including assessment of the intraoperative use of tranexamic acid and postoperative use of chemical thromboprophylaxis—in patients undergoing operative treatment of primary bone or soft-tissue sarcoma or oligometastatic bone disease. Methods: This study was performed as a secondary analysis of prospective data collected from the Prophylactic Anti)biotic Regimens in Tumor Surgery (PARITY) randomized controlled trial, which included 604 patients ‡12 years old who underwent surgical resection and endoprosthetic reconstruction for either primary bone or soft-tissue sarcoma or oligo)metastatic disease of the femur or tibia. We determined the incidence of thromboembolic events in these patients and evaluated potential risk factors, including patient age, sex, antibiotic treatment group, type of tumor (i.e., primary bone or soft-tissue sarcoma or metastatic bone disease), intraoperative tranexamic acid, tourniquet use, operative time, path)ologic characteristics (i.e., American Joint Committee on Cancer grade, vascular invasion, and percent necrosis), post)operative chemical thromboprophylaxis regimen, and surgical site infection. Continuous variables were assessed with use of the Student t test. Categorical variables were assessed with use of the Pearson chi-square test, except when the expected cell counts were <5, in which case the Fisher exact test was utilized. Significance was set at 0.05. Results: Postoperative thromboembolic events occurred in 11 (1.8%) of 604 patients. Patients who experienced a thromboembolic event had a significantly higher mean (± standard deviation) age (59.6 ± 17.5 years) than those who did not experience a thromboembolic event (40.9 ± 21.8; p = 0.002). Patients randomized to the long-term antibiotic group had a significantly higher incidence of thromboembolic events (9 of 293; 3.1%) than those randomized to the short-term antibiotic group (2 of 311; 0.64%; p = 0.03). Neither intraoperative tranexamic acid nor postoperative chemical thromboprophylaxis were significantly associated with the occurrence of a thromboembolic event. Conclusions: Although relatively rare in the PARITY cohort, thromboembolic events were more likely to occur in older patients and those receiving long-term prophylactic antibiotics. Intraoperative tranexamic acid and postoperative chemical thromboprophylaxis were not associated with a greater incidence of thromboembolic events. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSIs) represent a major complication following oncologic reconstructions. Our objectives were (1) to assess whether the use of postoperative drains and/or negative pressure wound therapy (NPWT) were associated with SSIs following lower-extremity oncologic reconstruction and (2) to identify factors associated with the duration of postoperative drains and with the duration of NPWT. Methods: This is a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial, a multi-institution randomized controlled trial of lower-extremity oncologic reconstructions. Data were recorded regarding the use of drains alone, NPWT alone, or both NPWT and drains, including the total duration of each postoperatively. We analyzed postoperative drain duration and associations with tourniquet use, intraoperative thromboprophylaxis or antifibrinolytic use, incision length, resection length, and total operative time, through use of a linear regression model. A Cox proportional hazards model was used to evaluate the independent predictors of SSI. Results: Overall, 604 patients were included and the incidence of SSI was 15.9%. Postoperative drains alone were used in 409 patients (67.7%), NPWT alone was used in 15 patients (2.5%), and both postoperative drains and NPWT were used in 68 patients (11.3%). The median (and interquartile range [IQR]) duration of drains and of NPWT was 3 days (IQR, 2 to 5 days) and 6 days (IQR, 4 to 8 days), respectively. The use of postoperative drains alone, NPWT alone, or both drains and NPWT was not associated with SSI (p = 0.14). Increased postoperative drain duration was associated with longer operative times and no intraoperative tourniquet use, as shown on linear regression analysis (p < 0.001 and p = 0.03, respectively). A postoperative drain duration of ‡14 days (hazard ratio [HR], 3.6; 95% confidence interval [CI], 1.3 to 9.6; p = 0.01) and an operative time of ‡8 hours (HR, 4.5; 95% CI, 1.7 to 11.9; p = 0.002) were independent predictors of SSI following lower-extremity oncologic reconstruction. Conclusions: A postoperative drain duration of ‡14 days and an operative time of ‡8 hours were independent predictors of SSI following lower-extremity oncologic reconstruction. Neither the use of postoperative drains nor the use of NPWT was a predictor of SSI. Future research is required to delineate the association of the combined use of postoperative drains and NPWT with SSI. [ABSTRACT FROM AUTHOR]

Ewing sarcomas (ES) are rare small round cell sarcomas often affecting children and characterized by gene fusions involving one member of the FET family of genes (usually EWSR1) and a member of the ETS family of transcription factors (usually FLI1 or ERG). The detection of EWSR1 rearrangements has important diagnostic value. Here, we conducted a retrospective review of 218 consecutive pediatric ES at diagnosis and found eight patients having data from chromosome analysis, FISH/microarray, and gene-fusion assay. Three of these eight ES had novel complex/cryptic EWSR1 rearrangements/fusions by chromosome analysis. One case had a t(9;11;22)(q22;q24;q12) three-way translocation involving EWSR1::FLI1 fusion and 1q jumping translocation. Two cases had cryptic EWSR1 rearrangements/fusions, including one case with a cryptic t(4;11;22)(q35;q24;q12) three-way translocation involving EWSR1::FLI1 fusion, and the other had a cryptic EWSR1::ERG rearrangement/fusion on an abnormal chromosome 22. All patients in this study had various aneuploidies with a gain of chromosome 8 (75%), the most common, followed by a gain of chromosomes 20 (50%) and 4 (37.5%), respectively. Recognition of complex and/or cryptic EWSR1 gene rearrangements/fusions and other chromosome abnormalities (such as jumping translocation and aneuploidies) using a combination of various genetic methods is important for accurate diagnosis, prognosis, and treatment outcomes of pediatric ES. [ABSTRACT FROM AUTHOR]