Exosomes are membranous vesicles with a 30 to 150 nm diameter secreted by mesenchymal stem/stromal cells (MSCs) and other cells, such as immune cells and cancer cells. Exosomes convey proteins, bioactive lipids, and genetic components to recipient cells, such as microRNAs (miRNAs). Consequently, they have been implicated in regulating intercellular communication mediators under physiological and pathological circumstances. Exosomes therapy as a cell-free approach bypasses many concerns regarding the therapeutic application of stem/stromal cells, including undesirable proliferation, heterogeneity, and immunogenic effects. Indeed, exosomes have become a promising strategy to treat human diseases, particularly bone- and joint-associated musculoskeletal disorders, because of their characteristics, such as potentiated stability in circulation, biocompatibility, low immunogenicity, and toxicity. In this light, a diversity of studies have indicated that inhibiting inflammation, inducing angiogenesis, provoking osteoblast and chondrocyte proliferation and migration, and negative regulation of matrix-degrading enzymes result in bone and cartilage recovery upon administration of MSCs-derived exosomes. Notwithstanding, insufficient quantity of isolated exosomes, lack of reliable potency test, and exosomes heterogeneity hurdle their application in clinics. Herein, we will deliver an outline respecting the advantages of MSCs-derived exosomes-based therapy in common bone- and joint-associated musculoskeletal disorders. Moreover, we will have a glimpse the underlying mechanism behind the MSCs-elicited therapeutic merits in these conditions.
Background: Osteosarcoma is a primary and malignant bone tumor. Currently, using neoadjuvant chemotherapy, surgery, and appropriate adjuvant chemotherapy, long-term survival of more than 70% can be expected for patients affected by this disease. Therefore, the combination of different treatment methods increases the chances of saving the limb. Objectives: In this study we intend to share our 10-year experience in the management of osteosarcoma in Shiraz as the referral center of south of Iran. Methods: In this retrospective cohort study, 56 patients with osteosarcoma who were referred to Chamran and Namazi hospitals between 2008 and 2017, were included. Age, sex, site of involvement, presence of metastasis, treatment procedure, treatment outcomes, and survival time were studied. Kaplan-Meier method was used for survival analysis. Log rank test was applied for comparison of survival time according to sex. SPSS software version 25 (SPSS Inc., Chicago, US) was used for statistical analysis. Significance level considered P-value less than 0.05. Results: Among these patients, 33 were men 23 were women, with an average of 10 to 68 years old. In our study, distal femur was the most common site for osteosarcoma. Moreover, 44.6% of the patients undergone amputation. The best treatment results are in patients who received neoadjuvant chemotherapy followed by surgery. Finally, 77% of patients had a 2-year survival rate, and 57% had a 5-year survival rate. Conclusions: There has been a significant advancement in the treatment of osteosarcoma. A multifaceted approach to this disease, including surgery and chemotherapy has increased the possibility of better prognosis for this disease. Early diagnosis and appropriate treatment in the form of neoadjuvant chemotherapy, surgery with appropriate margin removal, and adjuvant chemotherapy are suggested for this tumor.
Introduction: The novel COVID-19 disease was presented at first in Wuhan, China, in December 2019. During COVID-19 pandemic, approaching trauma patients, whom could have COVID-19, is a challenging issue required special consideration and healthcare setting.Methods and materials: This retrospective cohort study was conducted at Emtiaz hospital, the main trauma center of the south of Iran, between March 2020 and August 2020 from the beginning of the COVID-19 pandemic. Trauma-related data such as the mechanism of trauma, injury pattern, and surgical intervention procedure of all the suspicious COVID-19 patients were documented. ICU admission and mortality rate were investigated as outcome variables.Results: During six months of the pandemic period, 9248 patients were referred to our referral trauma center, with 222 patients suspicious of having COVID-19 infection. Among sixty-four cases, whom were confirmed to be positive, 33 orthopedic injured patients were observed. The mortality rate of COVID-19 positive cases was 15.6 % (10 patients out of 64) and COVID-19 negative ones was 10.1 % (16 patients out of 158) which was not statistically significant (p.value:0.25). Multivariate analysis of the effect of the baseline and trauma related factors on mortality rate, showed that older age (p. value: 0.001), COVID-19 infection (p. value: 0.033), and surgical procedure (p.value:0.038) are the poor prognostic factors associated with mortality rate.Conclusion: The mortality rate of trauma patients with COVID-19 positive infection was 15.6 % (10 patients). Older age, COVID-19 infection, and surgical procedure were observed as the statistically significant prognostic factors leading to more mortality rate.Level of Evidence: III
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