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Background: In recent times, our community has been inundated with an increasing number of amputees and of course an increasing number of people requiring lower limb prosthesis. We have also witnessed a surge in the prevalence of Diabetes, Diabetic Foot Syndrome and Diabetic foot gangrene. Aim: The aim of this study is to highlight the increasing contribution of Diabetic Foot Gangrene to our teaming population of Amputees and to emphasize that this can be ameliorated with definite, multidisciplinary Public Health Strategies aimed at increasing awareness to this ailment as well as early diagnosis and control of Diabetes. Methods: This was a descriptive, quantitative and prospective study of all amputations done at the University of Uyo Teaching Hospital and selected Private Hospitals in Uyo, Niger Delta region of Nigeria which is ongoing. Results: A total of 49 unilateral amputations of either the upper or lower limb were done. They were 21 Males and 28 Females. Patients in the 4th to 6th decades of life who had Diabetic foot gangrene, majority of whom were females were the highest number who underwent amputation 30 (61.2%). Most of the patients 27, out of 30 (90%) were diagnosed as Diabetic for the first time with foot gangrene. There is therefore a strong need to increase the awareness of our society to Diabetes and the negative effects of its complications particularly diabetic foot syndrome and gangrene. Conclusion: Diabetic foot gangrene was the commonest indication for amputation in this series and was responsible for 30 out of 49 (61.2%) amputations.

Background Context: Poor muscle health has been shown to predict poor perioperative outcomes following adult spinal deformity (ASD) surgery. Currently, there is limited data concerning the correlation between muscle health and recovery among patients undergoing ASD surgery., Purpose: To determine the relationship between normalized total psoas area (NTPA), postoperative mobility and adverse events (AEs) among patients undergoing ASD surgery., Study Design: Retrospective cohort study PATIENT SAMPLE: A retrospective analysis was performed at a single institution between January 2014 and December 2023 of patients undergoing ASD surgery by 10 board certified fellowship-trained orthopaedic spine surgeons., Outcome Measures: Primary outcome measures were postoperative ambulation distance on postoperative day (POD) 1, 2, 3, and 4 as well as perioperative adverse events including post-operative anemia requiring transfusion, ileus, urinary retention wound complication including dehiscence and infection, delirium, atelectasis, urinary tract infection (UTI), deep vein thrombosis (DVT), and epidural hematoma. Secondary outcome measures were 30-day reoperation rates, 30-day readmission rates, and postoperative length of stay (LOS)., Methods: Patients that underwent ASD surgery at a single center (2014-2023) were included in the study. NTPA was analyzed at the L3 and L4 mid-vertebral body on preoperative magnetic resonance imaging (MRI). Receiver operating characteristic (ROC) curve analysis was used to determine gender-specific NTPA cut-off values for predicting perioperative AEs. Patients were categorized as having a low NTPA if both L3 and L4 NTPA were below the cut-off values. Multivariate logistic regression was conducted to identify confounding predictors of perioperative AEs., Results: 279 patients (102 males, 177 females, mean age 61.2 ± 15.2 years) were included. ROC curve analysis demonstrated L3 NTPA <805 mm 2 /m 2 for males and <505 mm 2 /m 2 for females and L4 NTPA <912 mm 2 /m 2 for males and <714 mm 2 /m 2 for females as cut-off values predicting perioperative AEs. 103 patients (36.9%, 42 males, 61 females) were below these cut-off values and were in the low NTPA cohort. The remaining 176 patients (63.1%, 60 males, 116 females) were in the normal NTPA cohort. The low NTPA group had a higher overall perioperative AEs (70.9% vs 39.2%, p<0.001), and lower ambulation distances on postoperative day 1 and 2 compared to the normal NTPA group (p=0.021, p=0.028, respectively). On multivariate analysis, there were no other predictors of perioperative AEs., Conclusions: Low L3 and L4 NTPA is associated with lower early postoperative mobility and higher rates of perioperative AEs among patients undergoing ASD surgery. These findings stress the importance of muscle health in recovery after ASD surgery., Competing Interests: Conflicts of Interest Takashi Hirase, Myles Allen, Chukwuebuka Achebe, Michael Mazzucco, Robert Uzzo, Gregory Kazarian, Tejas Subramanian, Chad Simon, Atahan Durbas, Austin Kaidi, Kasra Araghi, Justin Samuel, Cole Kwas, Hiroyuki Nakarai, and Francis Lovecchio declare no potential conflicts of interests with respect to research, authorship, and/or publication of this article. Han Jo Kim has the following disclosures: Grant: ISSGF (Variable); Royalties: Zimmerbiomet (F), K2M Stryker (E), Acuity Surgical (B); Consulting: Nuvasive (B); Scientific Advisory Board/ Other Office, Vivex Biology (A), Aspen Medical (B); Fellowship Support: AO Spine (E). IRB Approval: This study protocol was conducted in accordance with the Declaration of Helsinki and received approval from the local institutional review board (Approval No: 2018-1599) with an exemption from requiring informed consent owing to the retrospective observational design of the study., (Copyright © 2024. Published by Elsevier Inc.)

Study Design: Retrospective cohort study., Objective: To determine the relationship between preoperative physical therapy (PT) and postoperative mobility, adverse events (AEs), and length of stay (LOS) among patients with low normalized total psoas area (NTPA) undergoing ASD surgery., Summary of Background Data: Sarcopenia as defined by low NTPA has been shown to predict poor perioperative outcomes following adult spinal deformity (ASD) surgery. However, there is limited evidence correlating the benefits of PT within the sarcopenic patient population., Methods: NTPA was analyzed at the L3 and L4 mid-vertebral body on preoperative magnetic resonance imaging (MRI). Receiver operating characteristic (ROC) curve analysis was used to determine gender-specific NTPA cut-off values for predicting perioperative AEs. Patients were categorized as having low NTPA if both L3 and L4 NTPA were below these cut-off values. Perioperative outcomes were compared between patients with low NTPA that underwent documented formal PT within 6 months prior to ASD surgery with those that did not., Results: 103 patients (42 males, 61 females) met criteria for low NTPA for inclusion in the study, of which 42 underwent preoperative PT and 61 did not. The preoperative PT group had a shorter LOS (111.2±37.5 vs. 162.1±97.0 h, P<0.001), higher ambulation distances (feet) on postoperative day (POD) 1 (61.7±50.3 vs. 26.1±69.0, P<0.001), POD 2 (113.2±81.8 vs. 62.1±73.1, P=0.003), and POD 3 (126.0±61.2 vs. 91.2±72.6, P=0.029), and lower rates of total AEs (31.0% vs. 54.1%, P=0.003) when excluding anemia requiring transfusion. Multivariable analysis found preoperative PT to be the most significant predictor of decreased LOS (OR 0.32, P=0.013)., Conclusion: Sarcopenic patients may benefit from formal preoperative PT prior to undergoing ASD surgery to improve early postoperative mobility, decrease AEs, and decrease LOS., Level of Evidence: 3., Competing Interests: Conflict of Interests: Han Jo Kim has the following disclosures: Acuity Surgical: Royalties; Vivex Biology: Medical or Scientific Advisory Board Membership; NuVasive: Medical or Scientific Advisory Board Member; Aspen Medical Products: Medical or Scientific Advisory Board Membership; HS2, LLC: Ownership/Equity/Investment; International Spine Study Group ISSG: Research Support; ZimmerBiomet: Royalties; K2 Medical LLC: Royalties; Spine STUD: Ownership/Equity/Investment; Manhattan School of Music: Board of Directors; FOCOS Hospital: Board of Directors, (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Porous tissue-engineered 3D-printed scaffolds are a compelling alternative to autografts for the treatment of large periorbital bone defects. Matching the defect-specific geometry has long been considered an optimal strategy to restore pre-injury anatomy. However, studies in large animal models have revealed that biomaterial-induced bone formation largely occurs around the scaffold periphery. Such ectopic bone formation in the periorbital region can affect vision and cause disfigurement. To enhance anatomic reconstruction, geometric mismatches are introduced in the scaffolds used to treat full thickness zygomatic defects created bilaterally in adult Yucatan minipigs. 3D-printed, anatomically-mirrored scaffolds are used in combination with autologous stromal vascular fraction of cells (SVF) for treatment. An advanced image-registration workflow is developed to quantify the post-surgical geometric mismatch and correlate it with the spatial pattern of the regenerating bone. Osteoconductive bone growth on the dorsal and ventral aspect of the defect enhances scaffold integration with the native bone while medio-lateral bone growth leads to failure of the scaffolds to integrate. A strong positive correlation is found between geometric mismatch and orthotopic bone deposition at the defect site. The data suggest that strategic mismatch >20% could improve bone scaffold design to promote enhanced regeneration, osseointegration, and long-term scaffold survivability., (© 2023 Wiley-VCH GmbH.)

Background: Despite being the second most common and deadliest cancer in males, prostate cancer could go unnoticed in the early stages. Prevention programs have been set in place to help in the early detection and reduction of mortality rates in developed countries., Objective: The aim of this study was to determine awareness, knowledge, and the uptake of prostate cancer screening tests. Another objective was to identify the factors that determine the uptake of prostate cancer screening among men living in Ido-Ekiti., Methods: A cross-sectional study was conducted among males aged 40 and above living in Ido-Ekiti in Ido-Osi local government area, Ekiti State, Nigeria. The sample size of 380 respondents was obtained using Leslie Fisher's formula., Results: The study revealed that the majority of the correspondents are aware of prostate cancer (57.9%). More than two-thirds of the respondents have poor knowledge of prostate cancer and the screening test (74.4%), with a median knowledge score of 30%. The uptake of prostate cancer screening tests was very low among the respondents (18.2%)., Conclusion: Despite the high level of awareness of prostate cancer disease among the respondents, the majority have poor knowledge of the disease and the screening test. There was a low uptake of prostate cancer screening tests among the respondents., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest., (©Copyright: the Author(s).)

Critical-sized midfacial bone defects present a unique clinical challenge due to their complex three-dimensional shapes and intimate associations with sensory organs. To address this challenge, a point-of-care treatment strategy for functional, long-term regeneration of 2 cm full-thickness segmental defects in the zygomatic arches of Yucatan minipigs is evaluated. A digital workflow is used to 3D-print anatomically precise, porous, biodegradable scaffolds from clinical-grade poly-ε-caprolactone and decellularized bone composites. The autologous stromal vascular fraction of cells (SVF) is isolated from adipose tissue extracts and infused into the scaffolds that are implanted into the zygomatic ostectomies. Bone regeneration is assessed up to 52 weeks post-operatively in acellular (AC) and SVF groups (BV/DV = 0.64 ± 0.10 and 0.65 ± 0.10 respectively). In both treated groups, bone grows from the adjacent tissues and restores the native anatomy. Significantly higher torque is required to fracture the bone-scaffold interface in the SVF (7.11 ± 2.31 N m) compared to AC groups (2.83 ± 0.23 N m). Three-dimensional microcomputed tomography analysis reveals two distinct regenerative patterns: osteoconduction along the periphery of scaffolds to form dense lamellar bone and small islands of woven bone deposits growing along the struts in the scaffold interior. Overall, this study validates the efficacy of using 3D-printed bioactive scaffolds with autologous SVF to restore geometrically complex midfacial bone defects of clinically relevant sizes while also highlighting remaining challenges to be addressed prior to clinical translation., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Vertebral compression fracture is a common complication of spinal stereotactic body radiation therapy. Development of an in vivo model is crucial to fully understand how focal radiation treatment affects vertebral integrity and biology at various dose fractionation regimens. We present a clinically relevant animal model to analyze the effects of localized, high-dose radiation on vertebral microstructure and mechanical integrity. Using this model, we test the hypothesis that fractionation of radiation dosing can reduce focused radiation therapy's harmful effects on the spine., Methods and Materials: The L5 vertebra of New Zealand white rabbits was treated with either a 24-Gy single dose of focused radiation or 3 fractionated 8-Gy doses over 3 consecutive days via the Small Animal Radiation Research Platform. Nonirradiated rabbits were used as controls. Rabbits were euthanized 6 months after irradiation, and their lumbar vertebrae were harvested for radiologic, histologic, and biomechanical testing., Results: Localized single-dose radiation led to decreased vertebral bone volume and trabecular number and a subsequent increase in trabecular spacing and thickness at L5. Hypofractionation of the radiation dose similarly led to reduced trabecular number and increased trabecular spacing and thickness, yet it preserved normalized bone volume. Single-dose irradiated vertebrae displayed lower fracture loads and stiffness compared with those receiving hypofractionated irradiation and with controls. The hypofractionated and control groups exhibited similar fracture load and stiffness. For all vertebral samples, bone volume, trabecular number, and trabecular spacing were correlated with fracture loads and Young's modulus (P < .05). Hypocellularity was observed in the bone marrow of both irradiated groups, but osteogenic features were conserved in only the hypofractionated group., Conclusions: Single-dose focal irradiation showed greater detrimental effects than hypofractionation on the microarchitectural, cellular, and biomechanical characteristics of irradiated vertebral bodies. Correlation between radiologic measurements and biomechanical properties supported the reliability of this animal model of radiation-induced vertebral compression fracture, a finding that can be applied to future studies of preventative measures., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction and Importance: Benign fibroblastic proliferation located within the scrotum are uncommon. They are also identified as fibrous pseudotumour and usually arise from the paratesticular region. Their pathogenesis is unknown. These tumours are difficult to diagnose pre-operatively and resemble intra-scrotal malignancy., Case Presentation: We managed a 26-year-old Nigerian man with a five-year history of left sided hemiscrotal swelling. The mass was excised, and histology showed benign fibroblastic proliferation., Discussion: Most paratesticular tumours are benign. Imaging studies that show the mass as separate from the testis, normal levels of tumour markers and clinical features not suggestive of malignancy make the case for organ-sparing mass excision, in the treatment of paratesticular fibrous pseudotumour, very strong., Conclusion: Intra-scrotal benign fibrous proliferation is a challenge to diagnose pre-operatively but excision of this benign mass without an orchidectomy is practicable when pre-operative assessment suggests a benign disease., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Adipose-derived stem cells (ASCs) are a promising cell source for regenerating critical-sized craniofacial bone defects, but their clinical use is limited due to the supraphysiological levels of bone morphogenetic protein-2 required to induce bone formation in large grafts. It has been recently reported that platelet-derived growth factor-BB (PDGF) directly enhances the osteogenesis of ASCs when applied at physiological concentrations. In this study, a biomimetic delivery system that tethers PDGF to decellularized bone matrix (DCB) is developed to enhance osteogenic signaling in bone grafts by colocalizing PDGF-extracellular matrix cues. Heparin is conjugated to DCB particles (HC-DCB) to promote sustained binding of PDGF via electrostatic interactions. HC-DCB particles bind to PDGF with >99% efficiency and release significantly less PDGF over 21 days compared to nonconjugated DCB particles (1.1% vs 22.8%). HC-DCB-PDGF signaling in polycaprolactone (PCL)-fibrin grafts promotes >40 µg Ca 2+ µg -1 DNA deposition by ASCs during in vitro osteogenic culture compared to grafts without HC-DCB or PDGF. Furthermore, more bone formation is observed in grafts with HC-DCB-PDGF at 12 weeks following implantation of grafts into murine critical-sized calvarial defects. Collectively, these results demonstrate that HC-DCB enhances the osteogenic signaling of PDGF to ASCs and may be applied to promote ASC-mediated bone regeneration in critical-sized defects., (© 2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)