Background: Microgravity (µG) negatively influences bone metabolism by affecting normal osteoblast and osteoclast function. µG effects on bone metabolism has been an extensive field of study in recent years, due to the challenges presented by space flight. Methods: We systematically reviewed research data from genomic studies performed in real or simulated µG, on osteoblast and osteoclast cells. Our search yielded 50 studies, of which 39 concerned cells of the osteoblast family and 11 osteoclast precursors. Results: Osteoblastic cells under µG show a decreased differentiation phenotype, proved by diminished expression levels of Alkaline Phosphatase (ALP) and Osteocalcin (OCN) but no apoptosis. Receptor Activator of NF-κB Ligand (RANKL)/ Osteoprotegerine (OPG) ratio is elevated in favor of RANKL in a time-dependent manner, and further RANKL production is caused by upregulation of Interleukin- 6 (IL-6) and the inflammation pathway. Extracellular signals and changes in the gravitational environment are perceived by mechanosensitive proteins of the cytoskeleton and converted to intracellular signals through the Mitogen Activated Protein Kinase pathway (MAPK). This is followed by changes in the expression of nuclear transcription factors of the Activator Protein-1 (AP-1) family and in turn of the NF-κB, thus affecting osteoblast differentiation, cell cycle, proliferation and maturation. Pre-osteoclastic cells show increased expression of the marker proteins such as Tryptophan Regulated Attenuation Protein (TRAP), cathepsin K, Matrix Metalloproteinase-9 (MMP-9) under µG conditions and become sensitized to RANKL. Conclusion: Suppressing the expression of fusion genes such as syncytine-A which acts independently of RANKL, could be possible future therapeutic targets for microgravity side effects.

In this study, we aimed to investigate the effectiveness of debridement, antibiotics, irrigation, and implant retention (DAIR) in periprosthetic hip joint infection caused by multidrug-resistant (MDR) Acinetobacter baumannii (A. baumannii) . From July 2019 to June 2020, we retrospectively reviewed all patients treated for periprosthetic hip joint infections caused by MDR A. baumannii at our institution. The diagnosis of periprosthetic joint infection (PJI) was established based on the Musculoskeletal Infection Society (MSIS) 2018 criteria. The Charlson Comorbidity Index (CCI) was used to estimate the risk of mortality. The patients were followed up for over a year, until their death, or loss to follow-up. Four patients (three females and one male), with a mean age of 68 years, were included in the study. A. baumannii exhibited resistance to fluoroquinolones in all cases. All patients were treated with the DAIR procedure followed by intravenous tigecycline and colistin combination treatment. Prosthesis retention with good functional results was achieved in two patients. One patient required resection arthroplasty and one patient died two months after the initial surgical treatment, yielding a success rate of 50% for the DAIR procedure. Periprosthetic hip joint infection caused by MDR A. baumannii is one of the most demanding and challenging complications in orthopaedic practice. This case series suggests that the outcome of the DAIR is affected by a number of factors that are in a complex interplay. Our results indicate a limited success rate for the DAIR procedure in the treatment of a periprosthetic hip joint infection caused by MDR A. baumannii .

Aim Ibuprofen and indomethacin are the preferred drug treatment for patent ductus arteriosus (PDA) in preterm neonates. The comparative safety and efficacy of paracetamol as an alternative has not yet been well established. The aim of our study was to define the comparative efficacy and safety of paracetamol versus ibuprofen and indomethacin for PDA. Methods We performed a systematic literature search in PubMed, Scopus and Cochrane databases on randomized controlled trials comparing the efficacy and/or the safety of paracetamol versus ibuprofen and/or indomethacin and meta‐analysed the available data. Results There were 1718 neonates from 20 eligible studies. Paracetamol did not differ from ibuprofen or indomethacin regarding the primary (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.69–1.26, P‐value: 0.650, when compared to ibuprofen, and OR: 0.78; 95% CI: 0.20–3.02, P‐value: 0.716, when compared to indomethacin) and overall (OR: 1.17; 95% CI: 0.82–1.66, P‐value: 0.394, when compared to ibuprofen, and OR: 1.12; 95% CI: 0.58–2.15, P‐value: 0.733, when compared to indomethacin) PDA closure rates. Paracetamol resulted in significantly reduced risk of oliguria and a tendency towards less gastrointestinal bleeding. Conclusion There was no significant difference between paracetamol and ibuprofen or indomethacin in the PDA closure rates. However, paracetamol caused fewer adverse effects.

Fragility hip fractures have become a worldwide epidemic with serious socioeconomic implications. The projected number of hip fractures by 2050 is estimated to reach 4.5 million cases. The aim of this study was to calculate the in-hospital financial burden on public health insurance funds related to the delayed treatment of hip fractures. This research took place in a tertiary university hospital that is a major trauma center in Thessaloniki, which is second largest city in Greece . A retrospective search was conducted in the electronic hospital database for patients older than 65 years, with low energy hip fractures that were surgically treated between November 18, 2018, and October 20, 2019. Age, length of stay (LOS), days to surgery, postoperative LOS, anticoagulation medication, major and minor complications, and the reimbursement that the hospital received from public health insurance funds were recorded. Cost deviation from the standard tariff for the treatment of these fractures was also calculated. Of a total of 145 patients, 32.4% had early surgery as opposed to 67.6% who were operated after 48 hours from admission. The excess financial burden from the baseline reimbursement for those operated within 48 hours from admission was 4,074.64€, while for the group that received delayed surgery it was 45,654.14€. Patients under any form of anticoagulation therapy were seven times more probable to have delayed surgery [OR=6.8; 95% confidence interval (CI): 2.97-18.18; p<0.01] and were 3.5 times more probable to have minor complications (OR: 3.6; 95% CI: 1.19-11.23; p<0.017). Early surgery is beneficial to the patient and reduces the economic burden on healthcare public funds. Every effort should be made to manage these patients in a timely manner.

The serpent is the most popular representative symbol of medicine. The two main figures commonly used are the rod of Asclepius and the caduceus. Much controversy exists in the literature on whether the caduceus is a false symbol for medicine or not. The history of how these depictions came to be ambassadors of the medical science is elusive to many physicians. Scholars suggest that the origin of this false belief dates back to 1902, when the US Army Medical Corps first incorporated the caduceus as its symbol. This current essay is an attempt to discover and interpret how the snake came to be part of the rod of Asclepius and the caduceus, and constitute the symbol of medicine in our days. It is widely accepted that a doctor’s obligation is not only in healing the ill, but the task that is bestowed upon him is more complex. Therefore, one should be considered more of a physician rather than simply a doctor