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Simple Summary: Advances in systemic cancer management have improved survival for numerous types of solid cancer; therefore, the number of patients harboring BM is increasing. According to established guidelines, resection should be carried out in patients with single brain metastases and controlled primary disease or when histopathologic diagnosis is crucial for decision-making in cancer management. Post-surgery rates of local recurrence are high; hence, adjuvant local radiation therapy (RT) is indicated to improve outcomes. So far, there is no standard of care regarding dose and fractionation; furthermore, delineation of the cavity can be challenging. Lately, low-energy X-ray intraoperative radiation therapy (IORT) applied to the resection bed has emerged in clinical practice, offering local ablative treatment with steep dose gradients towards the surrounding healthy brain. We here retrospectively describe 18 patients with resected brain metastases, which had undergone IORT, demonstrating the effectiveness and safety of this technique in accordance with previous studies. Background: Resection followed by local radiation therapy (RT) is the standard of care for symptomatic brain metastases. However, the optimal technique, fractionation scheme and dose are still being debated. Lately, low-energy X-ray intraoperative RT (lex-IORT) has been of increasing interest. Method: Eighteen consecutive patients undergoing BM resection followed by immediate lex-IORT with 16–30 Gy applied to the spherical applicator were retrospectively analyzed. Demographic, RT-specific, radiographic and clinical data were reviewed to evaluate the effectiveness and safety of IORT for BM. Descriptive statistics and Kaplan–Meyer analysis were applied. Results: The mean follow-up time was 10.8 months (range, 0–39 months). The estimated local control (LC), distant brain control (DBC) and overall survival (OS) at 12 months post IORT were 92.9% (95%-CI 79.3–100%), 71.4% (95%-CI 50.2–92.6%) and 58.0% (95%-CI 34.1–81.9%), respectively. Two patients developed radiation necrosis (11.1%) and wound infection (CTCAE grade III); both had additional adjuvant treatment after IORT. For five patients (27.8%), the time to the start or continuation of systemic treatment was ≤15 days and hence shorter than wound healing and adjuvant RT would have required. Conclusion: In accordance with previous series, this study demonstrates the effectiveness and safety of IORT in the management of brain metastases despite the small cohort and the retrospective characteristic of this analysis. [ABSTRACT FROM AUTHOR]

Introduction: Transcutaneous Osseointegrated Prosthetic Systems (TOPS) offer a good alternative for patients who cannot be satisfactorily rehabilitated by conventional suspension sockets. The Endo-Exo-Prothesis (EEP, ESKA Orthopaedic Handels GmbH®, Deutschland) is the most implanted TOPS in Germany. Previous studies have shown that cortical thickness increases after implantation of TOPS. The aim of this study is to determine changes of cortical thickness in relation to the time after implantation of the Endo-Fix-Stem. Patients and methods: All transfemoral amputees treated by EEP from 2007 to 2013 were operated by the last author of this study. X-ray images of 4 follow-up intervals (postoperative, 3 months, 12 months, 3 years) were analyzed retrospectively. The femoral residuum was divided into 3 sections (proximal, middle, distal) with 2 measuring points in each section: medial and lateral. Cortical thickness was measured at these 6 points and compared at regular intervals using the Friedman test for non-parametric dependent variables. Results: Thirty-seven patients with 40 implants were included. The average age was 52.2 years (30–79 years). 83.7% of the patients were male. No statistical significance could be shown for any of the measuring points of the femoral residual (proximal medial, proximal lateral, middle medial, middle lateral, distal medial, distal lateral) among the mean values of the cortical thickness at the different follow-up times (p > 0.05 for all measuring points). Cortical remodeling processes (> 1 millimeter (mm)) occurred in all implants despite a missing statistical significance. Hypertrophy could be confirmed for 42.5% and atrophy for 37.5%. Twenty percent of the cases showed a parallel occurrence of both entities. Cortical changes greater than 5 mm were only observed at the distal end of the femur. Conclusion: Even if our results did not show any significant difference, it can be deduced that the osseointegration process leads to a remodeling of the bone structure, both in terms of increased bone formation and bone resorption. However, it has not yet been conclusively clarified which processes lead to hyper- or atrophy. The force transmission between prosthesis and bone and the facultative bacterial colonization of the stoma are still the main factors which may be responsible for the bone remodeling processes. [ABSTRACT FROM AUTHOR]

A positive effect of intra-articular platelet-rich plasma (PRP) injection has been discussed for osteoarthritic joint conditions in the last years. The purpose of this study was to evaluate PRP injection into the trapeziometacarpal (TMC) joint. We report about ten patients with TMC joint osteoarthritis (OA) that were treated with 2 intra-articular PRP injections 4 weeks apart. PRP was produced using the Double Syringe System (Arthrex Inc., Naples, Florida, USA). A total volume of 1.47±0.25 mL PRP was injected at the first injection and 1.5±0.41 mL at the second injection, depending on the volume capacity of the joint. Patients were evaluated using VAS, strength measures, and the Mayo Wrist score and DASH score after 3 and 6 months. VAS significantly decreased from 6.2±1.6 to 5.4±2.2 at six-month follow-up (P<0.05). The DASH score was unaffected; however, the Mayo Wrist score significantly improved from 46.5±18.6 to 67.5±19.0 at six-month follow-up (P=0.05). Grip was unaffected, whereas pinch declined from 6.02±2.99 to 3.96±1.77 at six-month follow-up (P<0.05). We did not observe adverse events after the injection of PRP, except one occurrence of a palmar wrist ganglion, which resolved without treatment. PRP injection for symptomatic TMC OA is a reasonable therapeutic option in early stages TMC OA and can be performed with little to no morbidity. [ABSTRACT FROM AUTHOR]

The monastery of Attel, Upper Bavaria, which was founded in AD 1030, harbours a series of crypt burials from the time period between AD 1700 and 1750. Due to a restoration of the church, 16 crypts had to be removed and were subjected to an extensive anthropological-paleopathological and isotope analysis. The 16 crypts contained 19 burials in open wooden coffins. All bodies were covered by an extensive layer of calcium carbonate. Despite this “treatment,” bone and teeth were excellently preserved (mean degree of conservation > 75%, completeness > 85%). The anthropological investigation revealed a mean age of 38.5 years and a body height of 1.71 m. Paleopathologically, a surprisingly high rate of trauma was seen (13 injuries in 7 different individuals, i.e., 36.8% of individuals affected), 2 cases presented signs of extensive arthritis urica (gout), and several monks were affected by arthrosis of shoulder and knee joints. Extensive dental attrition, numerous foci of dental caries, and dentogenic abscesses coincided with considerable dental calculus indicating poor oral hygienic conditions. Stable isotope analysis showed adequate mixed carnivore-herbivore nutrition, comparable to that of contemporaneous upper class individuals. This extensive combined analysis provides considerable insight into the nutrition and disease pattern of a middle-class monastery of early 18th century South Germany. [ABSTRACT FROM AUTHOR]

Background: Growth restriction and retarded bone age are common findings in children with chronic kidney disease (CKD). We compared the automated BoneXpert™ method with the manual assessment of an X-ray of the non-dominant hand. Methods: In this retrospective multicenter study, 359 patients with CKD stages 2-5, aged 2-14.5 (girls) or 2.5-17 years (boys) were included. Bone age was determined manually by three experts (according to Greulich and Pyle). Automated determination of bone age was performed using the image analysis software BoneXpert™. Results: There was a strong correlation between the automatic and the manual method ( r = 0.983, p < 0.001). The automatic method tended to generate higher bone age values (0.64 ± 0.73 years) in the younger patients (4-5 years) and to underestimate retardation or acceleration of bone age. The so-called 'bone health index' (BHI) was reduced in comparison to the reference population. Bone health index standard deviation score (BHI-SDS) was not related to the stage of CKD, but weakly negatively correlated with plasma PTH concentrations ( r = 0.12, p = 0.019). Conclusions: BoneXpert™ allows an objective, time-saving, and in general valid bone age assessment in children with CKD. Possible underestimation of retarded or accelerated bone age should be taken into account. Validation of the BHI needs further study. [ABSTRACT FROM AUTHOR]