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Glycoprotein non‑metastatic melanoma protein B (GPNMB) is a glycoprotein that is highly expressed in various types of cancer, including osteosarcoma. However, its cellular functions and related mechanisms in osteosarcoma remain unclear. In the present study, a higher GPNMB mRNA level was observed in osteosarcoma tissues, than in adjacent non‑cancerous tissues. In addition, upregulation of the GPNMB mRNA and protein level was detected in the osteosarcoma cells SaOS2, 143B, MG63 and U2OS using western blot analysis and qPCR. Following transfection with GPNMB siRNA, the proliferation, migration and invasion of MG63 and U2OS cells were assessed using MTT and Transwell assays. The knockdown of GPNMB markedly inhibited the proliferation and metastasis of MG63 and U2OS cells. GPNMB silencing inhibited the activation of PI3K/Akt/mTOR signaling in MG63 and U2OS cells. PI3K/AKT activator insulin‑like growth factor‑1 (IGF‑1) significantly activated the PI3K/Akt/mTOR signaling and reversed the suppressive effects of GPNMB silencing. IGF‑1 counteracted the inhibitory effects of GPNMB silencing on the proliferation and metastasis of the MG63 and U2OS cells. In conclusion, we provided evidence that GPNMB silencing regulated the proliferation and metastasis of osteosarcoma cells by suppressing the PI3K/Akt/mTOR signaling pathway. Thus, GPNMB may be a potential therapeutic target for osteosarcoma treatment.

Rationale:Refractory immune thrombocytopenic purpura (RITP) manifests as low platelet count, with a high risk of hemorrhage, treatment difficulty, and high mortality. Total hip arthroplasty (THA) in RITP is rarely reported. This study aimed to evaluate multiple THAs or revision total hip arthroplasties (RTHAs) in RITP.Patient concerns:The male patient with RITP was 54-year-old patient and hospitalized on September 21, 2009, with the main complaint of bilateral hip pain after traveling for 2 weeks. The patient had a history of ITP for 16-years, with no response to hormone therapy (after adequate hormone therapy, platelet count persistently remained below 30 × 109/L). Two year prior to visit, the patient underwent splenectomy, and postoperative platelet persistently fluctuated around 10 to 20 × 109/L. The patient did not undergo regular reexaminations, and declined immunosuppressants.Diagnoses:Femoral neck fracture; Refractory immune thrombocytopenic purpura (RITP).Interventions:A RITP patient with femoral neck fracture received 2 THAs and 1 RTHA. First THA indication was significant left dislocation of Garden III type. RTHA was performed following prosthetic loosening after left total hip arthroplasty. The second THA was prompted by non-healing of the old fracture, significant pain, and a low Harris score. Platelet count remained <20 × 109/L, and conventional drugs, splenectomy, and platelet transfusion had no effects. A large gamma-globulin dose was administered preoperatively. When platelet increased to 75 × 109/L, 2 THAs and 1 RTHA were successfully completed.Outcomes:Postsurgery, conventional management was applied; no severe complications occurred. The wound was well healed, with platelet count reduced to <15 × 109/L at hospital discharge. The patient recovered, with a Harris score >80 at 1 year postsurgery.Lessons:Extremely low platelet count is a contraindication of surgery. In this patient, preoperative platelet count was <100 × 109/L. Extended disease course and multiple operations lowered platelet count, and increased risk in surgery. However, high postoperative gamma-globulin dose impacted therapy, and all surgeries were successful, with no severe complications. The wound healed well, and the quality of life was significantly improved, demonstrating the feasibility and safety of this surgery. Multiple THA or RTHA surgeries are feasible and safe for RITP patients.

A rare case of neonatal congenital coronary artery, right ventricle fistula with giant coronary artery aneurysm formation, was reported. Computed tomography angiography demonstrated the dilated and tortuous tunnel arising from the right aortic sinus and traversing the epicardial surface before opening into the anterolateral aspect of the RV. Successful surgical repair was performed with a patch closure of the fistula and coronary angioplasty. The postoperative recovery was uneventful. Our experience of this rare congenital heart disease demonstrated that early surgical repair of coronary artery fistula and coronary angioplasty in the neonate can be performed safely. Further study is needed to seek the basis on this.