Osteoprotegerin (OPG) is a secreted member of the Tumor Necrosis Factor (TNF) receptor superfamily (TNFRSF11B), that was first characterized and named for its protective role in bone remodeling. In this context, OPG binds to another TNF superfamily member Receptor Activator of NF-kappaB Ligand (RANKL; TNFSF11) and blocks interaction with RANK (TNFRSF11A), preventing RANKL/RANK stimulation of osteoclast maturation, and bone breakdown. Further studies revealed that OPG protein is also expressed by tumor cells and led to investigation of the role of OPG in tumor biology. An increasing body of data has demonstrated that OPG modulates breast tumor behavior. Initially, research was focused on OPG in the bone microenvironment as a potential inhibitor of RANKL-driven osteolysis. More recently, attention has shifted to include OPG expression and interactions in the primary breast tumor independent of RANKL. In the primary tumor, OPG may interact with another TNF superfamily member, TNF-Related Apoptosis Inducing Ligand (TRAIL; TNFSF10) to prevent apoptosis induction. Additional interest in OPG in breast cancer has been stimulated by the tumor-promoting role of its binding partner RANKL in association with BRCA1 gene mutations. We and others have previously summarized the functional studies on OPG and breast cancer (1, 2). After basic research studies on the in vitro role for OPG (and RANKL) in breast cancer, the field now expands to assess the in vivo role for OPG by examining the correlation between OPG expression and breast cancer risk or patient prognosis. However, the data reported so far is conflicting, since OPG expression appears linked to both good and poor patient survival. In the current review we will summarize these studies. Our goal is to provide stimulus for further research to bridge the basic research findings and clinical data regarding OPG in breast cancer.

Our patient was a 57-year-old woman with a history of bilateral retropectoral silicone breast augmentation and axillary hyperhidrosis who underwent a bilateral thoracic sympathectomy via video-assisted thoracoscopic surgery by a surgeon at an outside hospital approximately 20 years ago. The left side required an open thoracotomy. Shortly after the surgery, she developed a left-sided Baker 4 capsular contracture and the left implant was noted to be ruptured. Both implants were exchanged. Several years later the patient began to experience progressive fatigue. Work-up revealed a left lung nodule and she underwent a biopsy that confirmed silicone granulomas. It was hypothesised that at the time of her initial thoracotomy the implant was violated resulting in silicone spillage into the thoracic cavity. The patient was referred to our institution for advanced management of her intrathoracic silicosis. The patient underwent bilateral removal of her silicone implants, total capsulectomy and needle-localised removal of her left thoracic silicone masses. She had an uneventful postoperative course with resolution of her fatigue.

Patient education is an essential aspect of surgical practice, as it improves patient compliance, trust in providers, and health outcomes (Paterick, 2017). Barriers to education, such as language and health literacy, are a challenge to this process (Behmer Hansen, 2020). The Census Bureau’s 2018 American Community Survey found that 38% of English-second-language (ESL) Americans speak English “less than very well” (McHugh, 2019). Despite this, most patient education material is only guaranteed in the English language, and is written at a reading level much higher than the national average (Behmer Hansen, 2020). Beyond issues of informed consent and procedure comprehension, faulty engagement with healthcare providers is a source of great risk to patient health (Sharma, 2018). Failure to meet the low health literacy requirements of a patient population occurs regardless of surgical specialty. Neurosurgical patient education materials have been labeled as difficult to understand, creating a significant barrier in maintaining patient engagement (Ramos, 2019). Orthopedic and hand surgery education materials have also been found to be at unrealistically high reading levels (Hadden 2016, Prince 2019).

Background We performed a retrospective chart review on COVID-19 patients treated at Arrowhead Regional Medical Center (ARMC) in Colton, California from January through October 2020. Two outcomes were measured: time to recovery and mortality outcome. Models were subsequently generated to investigate the role of remdesivir on these patient outcomes. Methods This study compares data on the Top 20 MSAs with the highest cumulative COVID-19 case rate at two timepoints (October 13, 2020 and January 1, 2021). The means of CDC’s Social Vulnerability Index (SVI) variables for the highest risk MSAs were compared with the Welch Two Sample t-test to the means of the SVI variables for the rest of the U.S. Results While initial research indicated that remdesivir decreased time to recovery, we found no such appreciable decrease in our study population. Our data corroborates existing studies on the lack of remdesivir’s impact on mortality. When controlling for days from symptom onset to administration of this medication, these outcomes do not change. Conclusion Our data demonstrate that remdesivir does not significantly alter time to recovery or mortality in COVID-19 patients. While the National Institute of Health (NIH) has sanctioned remdesivir’s use for certain COVID-19 populations, we do not observe any appreciable effects of this implementation at our county hospital. Increasing sample size and investigating inclusion criteria may help elucidate this observed lack of effect.

Background: There exists a paucity of data on which pediatric facial fractures should be surgically repaired and when. In this study, the authors used a California state-wide database to determine the prevalence of facial fractures in the pediatric population and examine, which fractures are repaired. in addition to the timing of the repair, complications and resource utilization of the healthcare system were analyzed. Methods: Pediatric patients under the age of 18 were identified using the California Office of Statewide Health Planning and Development patient discharge database for admissions occurring between January 2015 and December 2018. International Classification of Diseases, Version 10 diagnosis codes were used to classify facial fractures. The associated diagnoses, complications, and number of subsequent repairs patients underwent were analyzed to determine the typical course of pediatric facial fractures. Results: Of the 3058 patients diagnosed with facial fracture, 32% underwent surgical repair (N = 982). The 4 most repaired fractures were mandible (40%), nasal (16.2%), and orbital (15.1%). Surgical intervention steadily increased with age, with a peak in the 12 to 15-year-old cohort. Conclusions: Our analysis found that most fractures were managed nonoperatively, but those that did receive an operation did so during their index admission. In addition, the most repaired fractures were mandibular, nasal, and orbital fractures. The present study represents 1 of the largest pediatric samples to have assessed facial fractures, repair rates, and their sequelae.