The researchers found that the protein – interleukin-11 receptor alpha (IL-11Ra) – is highly expressed in primary osteosarcoma and in lung metastases from these tumors. Their research suggests the possibility of delivering therapeutic agents directly to osteosarcoma cells by targeting the receptor with circulating particles that display a peptide mimic of the natural ligand that binds IL-11Ra.

Osteosarcoma is the most common primary malignant tumor of bone. “Existing treatment has not changed the prognosis for osteosarcoma for the last 20 to 30 years,” said lead investigator Valerae O. Lewis, M.D., associate professor and chief of Orthopedic Oncology at M. D. Anderson. “About 30 percent of patients still relapse and die of their disease. New therapeutic strategies and agents are needed.”

The effectiveness of the current chemotherapy regimens for osteosarcoma is limited by toxic side effects, including damage to the heart and nerves, kidney failure and hearing loss, Lewis noted. Identification of a target specific for osteosarcoma cells opens the door for the development of therapies that can shut down the tumor cells without inflicting the collateral damage caused by conventional osteosarcoma treatments.

IL-11Ra is a target in bone metastasis; far less is known about its attributes, if any, in primary tumors of bone. To address IL-11Ra as a potential molecular target in osteosarcoma, the authors confirmed the protein expression and localization of IL-11Ra in several mouse and human osteosarcoma cell lines.

In an orthotopic mouse model of human osteosarcoma, the investigators found that the IL-11Ra not only was markedly present in the primary osteosarcoma and in its metastases but was absent from normal bone marrow and lungs.

To evaluate the accessibility of IL-11Ra as a target, the researchers intravenously administered small, virus-like particles called phages equipped with a peptide that mimics IL-11, the receptor’s natural ligand. After 24 hours in circulation, the ligand-directed particles were taken up in the tumors but showed little or no accumulation in several control organs.

“Connecting therapeutic agents to this ligand-directed system might result in improved, targeted drugs,” said co-senior author Renata Pasqualini, Ph.D., Professor of Medicine and Cancer Biology in the David H. Koch Center at M. D. Anderson.

“It is conceptually unexpected that a receptor would be over-expressed not only in metastatic tumors to bone but also in primary bone tumors; this is quite important because human osteosarcoma is a malignant tumor with very few targets at the protein level,” said co-senior author Wadih Arap, M.D, Ph.D., also Professor of Medicine and Cancer Biology in the David H. Koch Center.

Immunohistochemical staining analysis of IL-11Ra expression in primary and metastatic human osteosarcoma samples provided further evidence of the potential value of IL-11Ra as a therapeutic target. All primary human osteosarcoma samples exhibited moderate-to high-intensity staining of tumor cells. More than half of tumor blood vessels also showed moderate-to-high-intensity staining. All pulmonary metastases were positive for IL-11Ra expression, while normal, control lung tissue was negative.

“This indicates that therapeutic targeting of IL-11Ra may yield anti-tumor, anti-metastasis and anti-angiogenesis effects in osteosarcoma,” Lewis said.

Phase I trial of IL-11R for bone metastasis

The U.S. Food and Drug Administration recently issued “safe to proceed” status for an M. D. Anderson-sponsored investigational new drug based on a cell-death-inducing therapy directed at IL-11R. The drug is defined as BMTP-11 (Bone Metastasis Targeting Peptide 11). The first clinical trial, in which BMTP-11 will be evaluated in prostate cancer patients, will soon be activated.

Lewis noted that the research group has initiated pre-clinical studies to measure potential anti-tumor effects of BMTP-11 in osteosarcoma models. If successful, such efforts may lead to a rapid evolution of BMTP-11 toward the management of osteosarcoma.

Research was funded by an M. D. Anderson Institutional Research Grant and a Robert Wood Johnson Foundation grant to Lewis and grants from the National Institutes of Health, the U.S. Department of Defense, the Gillson-Longenbaugh Foundation, and the Marcus Foundation, to Arap and Pasqualini.

Co-authors with Lewis, Arap and Pasqualini are Michael G. Ozawa, in the David H. Koch Center M. D. Anderson and an M.D./Ph.D. student in the Graduate School of Biomedical Sciences, operated jointly by The University of Texas Health Science Center at Houston and M. D. Anderson; Guiyang Wang, of the Department of Orthopedic Oncology; Michael T. Deavers, M.D. of M. D. Anderson’s Department of Pathology; and Tamaki Shintani, D.D.S., Ph.D., of M. D. Anderson’s Department of Radiation Oncology.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 41 Comprehensive Cancer Centers designated by the National Cancer Institute. For six of the past nine years, M. D. Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News and World Report.

The research was the work of lead author Dr Michael Gnant of the Medical University of Vienna in Austria and colleagues from other research centres in Austria and Germany and is published online in the 12 February issue of the New England Journal of Medicine.

Zoledronic acid is normally used to prevent bone fractures in patients with cancer and to treat bone diseases such as postmenopausal osteoporosis; it is is marketed by Novartis as Zometa, Zomera, Aclasta and Reclast.

Some pre-clinical studies have suggested that zoledronic acid has antitumor properties, so the researchers decided to investigate the effect of adding it to the standard treatment for premenopausal women with endocrine-receptive early breast cancer.

For the study, the researchers recruited 1,803 premenopausal women with early stage endocrine-responsive breast cancer and randomly assigned them to receive goserelin (stops the production of estrogen) and tamoxifen, or anastrozole (an aromatase inhibitor normally used to treat postmenopausal women with breast cancer) with or without zoledronic acid. The women underwent the therapy for three years.

The primary outcomes that the researchers looked for were disease-free survival and recurrence-free survival, with overall survival as a secondary measure.

After a median follow up of 47.8 months, 137 events had occurred, with the following results:

* The disease-free survival in the tamoxifen group was 92.8 per cent.

* In the anastrozole group it was 92.0 per cent, with 90.8 in the endocrine therapy only subgroup and 94.0 per cent in the subgroup that also received zoledronic acid.

* There was no significant difference in disease-free survival between the tamoxifen and anastrozole groups.

* Compared to endocrine therapy alone, adding zoledronic acid resulted in an absolute reduction of 3.2 per cent and a relative reduction of 36 per cent in the risk of disease progression.

* Adding zoledronic acid did not significantly reduce the risk of death.

* There were no unexpected adverse events, these were within known safety profiles for the drugs concerned.

* Women who received zoledronic acid were more likely to report bone pain (35 vs 25 per cent), arthralgias (24 vs 18 per cent), and fever (9 vs 2 per cent) than those who did not.

* No documented cases of osteonecrosis of the jaw were observed.

The authors concluded that:

“The addition of zoledronic acid to adjuvant endocrine therapy improves disease-free survival in premenopausal patients with estrogen-responsive early breast cancer.”

Writing in NEJM‘s Journal Watch, Women’s Health, Deputy Editor Dr Andrew Kaunitz, who is Professor and Associate Chair of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine, drew attention to the differences between US practice and the methods used in other countries such as reflected in this Austro-German study:

“Use of ovarian-suppression therapy rather than cytotoxic chemotherapy deserves comment. In the US, chemotherapy conventionally is offered to premenopausal women after initial surgery or radiation therapy for low- or intermediate-risk receptor-positive breast cancer; however, in other countries, ovarian-suppression therapy is often employed in this setting.”

Commenting on the findings, Kaunitz wrote they:

“Suggest that good outcomes can be achieved with ovarian-suppression therapy and that addition of ZA [zoledronic acid] further improves outcomes.”

“Antitumor effects exerted by ZA seem to promote beneficial results, both within the skeleton and at nonskeletal sites in premenopausal breast cancer patients who receive ovarian-suppression therapy,” added Kaunitz.

“Endocrine Therapy plus Zoledronic Acid in Premenopausal Breast Cancer.”
Gnant, Michael, Mlineritsch, Brigitte, Schippinger, Walter, Luschin-Ebengreuth, Gero, Postlberger, Sabine, Menzel, Christian, Jakesz, Raimund, Seifert, Michael, Hubalek, Michael, Bjelic-Radisic, Vesna, Samonigg, Hellmut, Tausch, Christoph, Eidtmann, Holger, Steger, Gunther, Kwasny, Werner, Dubsky, Peter, Fridrik, Michael, Fitzal, Florian, Stierer, Michael, Rucklinger, Ernst, Greil, Richard, the ABCSG-12 Trial Investigators.

– Find the proper bicycle equipment by seeking out professional advice before making a purchase

– Always position the seat, handlebars and other bike parts properly in relation to the rider’s body size

– Wear a properly fitted helmet

– Stretch prior to cycling especially the following areas:

- Gluteal Muscles
- Hamstring Muscles
- Quadricep Muscles
- Calf Muscles

–Take proper care at first sign of injury including:

- Rest
- Ice
- Compress
- Elevate
- See a doctor if pain persists

According to statistics from the U.S. Consumer Product Safety Commission, more than a million people are treated in hospitals, doctor’s offices and clinics each year because of bicycle injuries. “We are seeing an increased interest in cycling as a sport. With the baby boomers getting older, it is a popular alternative to running, which is more of a strain on an aging frame,” says Dr. Tony Wanich, the study’s lead author and an orthoapedic resident at the Hospital for Special Surgery in New York. “Part of the problem is that the majority of people do not go to a bike shop to test ride a bike, they just buy off the rack, not paying very much attention to the proper fit.” While cycling is good for joint movement and flexibility, overuse of joints and muscles can happen very easily resulting in injury. Those injuries include:

- Knee pain
- Hip tendonitis
- Stress fractures
- Foot numbness

However, the knee is the most common location for overuse, with 40-60 percent of riders experiencing knee pain. Most of the time these injuries do not require surgery, instead treatment usually includes:

- Rest
- Nonsteroidal anti-inflammatory drugs
- Corticosteroid injection
- Ice
- Reducing intensity of cycling
- Physical therapy

“Overall cycling is a relatively safe activity and is a terrific option for many individuals, especially those with musculoskeletal aliments. Riders can prevent most injuries by taking the proper safety precautions,” Dr. Wanich says. “Lance Armstrong did a lot to educate and excite people about cycling; now we need to take care and properly fit our bicycles to prevent possible injuries.”

American Academy of Orthopaedic Surgeons

La Chirurgia degli Organi di Movimento – Musculoskeletal Surgery, founded in 1917 at the Istituti Ortopedici Rizzoli in Bologna, Italy, is a peer-reviewed journal which is international in scope and readership. Its editorial team, including experts from around the globe, is headed by Sandro Giannini and Armando Giunti. Providing up-to-date information to orthopedic clinicians and practitioners, the journal publishes original papers, reviews, case reports and brief communications dealing with surgical treatment of diseases and injuries of the musculoskeletal system.

Carlotta d’Imporzano, Managing Editor, Medical Journals, at Springer Italy, said, “La Chirurgia degli Organi di Movimento benefits from a long tradition and is already well known and cited by experts all over the world. To further enhance the journal’s visibility, the print version is now supported by its electronic counterpart at www.springerlink.com. Springer, with its publishing expertise, can help the journal reach its growth objectives.”

La Chirurgia degli Organi di Movimento is published at Springer online and in print. The journal includes Online First™, Cross Reference Linking, and Alert services. All authors, via the Springer Open Choice™ program, have the option of publishing their articles using the open access publishing model.

The AHRQ report compared the effectiveness and risks of six bisphosphonates: alendronate (sold as Fosamax), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel) and zoledronic acid (Zometa). The report also looked at estrogen, calcitonin (a man-made hormone), calcium, vitamin D, testosterone, parathyroid hormone and selective estrogen receptor modulators (SERMs).

Not enough scientific evidence exists to establish whether bisphosphonates are better at preventing fractures than estrogen, calcitonin or raloxifene, according to the report. Some agents, however, such as estrogen and raloxifene (a SERM), can have serious side effects such as strokes, blood clots in the lungs or bleeding in the uterus.

The effectiveness of calcium and vitamin D, meanwhile, may vary according to dosing, how often they are taken and whether the patient taking them is at high risk for a fracture. There is limited evidence to compare the supplements with other therapies for preventing fractures.

The report also found that many osteoporosis patients stop taking their medications as prescribed. Some stop because they experience no osteoporosis symptoms. Others stop because of medication side effects or because dosing is too frequent. This finding was also true for supplements such as calcium. Not taking medications as prescribed increases the chances of bone fractures. Patients who take bisphosphonates in weekly formulations, rather than daily, are more likely to follow prescriptions. An article based on the report will be posted Monday online in the Annals of Internal Medicine.

“As more Americans live longer, osteoporosis will have a greater impact on health and quality of life,” said AHRQ Director Carolyn M. Clancy, MD. “This report will help health care providers and patients understand what we really know – and don’t know – about the array of available treatments.”

Osteoporosis is a skeletal disease that affects about 44 million Americans, especially women who have finished menopause. It occurs when deteriorating tissue reduces bone density in the spine, hip and other areas. Some people with the disease fracture bones, become disabled or experience chronic pain. Overall, about half of women age 50 and older will suffer an osteoporosis-related bone break in their lifetime. About one-fourth of those who fracture a hip will die within a year.

Bisphosphonates, the most commonly used medications for osteoporosis, are non-hormonal drugs that bind to bone to protect against tissue breakdown. AHRQ’s analysis found that five bisphosphonates – alendronate, etidronate, ibandronate, risedronate and zoledronic acid – plus calcitonin, parathyroid hormone, estrogen and raloxifene prevent spinal fractures. Evidence also showed that alendronate, risedronate and zoledronic acid, as well as estrogen and parathyroid hormone, prevent hip and other non-spinal fractures.

Direct comparisons, however, have not shown bisphosphonates to be superior to other therapies in preventing bone fractures. No single bisphosphonate has been proven most effective in that class.

The AHRQ report, Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis, summarized the scientific evidence in 101 published articles. It was authored by the Southern California Evidence-based Practice Center at the RAND Corporation in Santa Monica, CA.

Among the conclusions:

- Among post-menopausal women with osteoporosis, alendronate, etidronate, ibandronate, risedronate, calcitonin, teriparatide (a form of PTH) and raloxifene reduce fracture risks.

- Not enough evidence exists to determine how exercise or taking testosterone compares to medications in preventing osteoporosis-related fractures.

- Calcitonin, risedronate and teriparatide reduce fracture risks among men.

- For people at increased risk of falling, such as those with partial paralysis or Parkinson’s disease, fracture risks are reduced if they are treated with alendronate, risedronate or vitamin D.

- Risks associated with many osteoporosis treatments are generally moderate or small. Although ulcers in the esophagus were reported in trials of all the bisphosphonates except zoledronic acid, these also occurred in patients not taking these drugs.

- Patients who take raloxifene face increased risk of blood clots in the lungs and other areas as well as mild cardiac problems such as chest pains or palpitations. One study found tamoxifen (a SERM) increased the risk of lung blood clots.

- In rare cases, dramatic jaw bone deterioration can occur in cancer patients taking intravenous bisphosphonates in large doses.

The report on osteoporosis medications is the newest analysis from AHRQ’s Effective Health Care program. That program represents an important federal effort to compare alternative treatments for significant health conditions and make the findings public. The program is intended to help patients, doctors, nurses and others choose the most effective treatments. Information on the program, including full reports, can be found at http://www.effectivehealthcare.ahrq.gov.

This new Garden City office is located in the hometown of renowned orthopaedist, Dr. Giles R. Scuderi, a director of ISK. According to Dr. Scuderi, the people of Long Island realize that they no longer have to go into New York City to receive top orthopaedic care, and have been pouring into their Garden City location.

“Each new office allows us to offer full service, state-of-the-art orthopaedic care to more patients, including treatment of the shoulder, knee and hip; foot and ankle trauma; sports medicine and adult reconstruction,” said Scuderi. “Many of our patients are able to quickly return to an active lifestyle even after a total knee replacement.”

Dr. Scuderi specializes in all disorders of the knee. He has pursued innovative developments in MIS surgery, partial knee replacement, gender specific knee design and revision total knee replacement. He was the first on Long Island to offer knee replacement shaped to fit a woman’s anatomy and currently serves on numerous orthopaedic editorial boards.

In addition to treating patients, Dr. Scuderi publishes and lectures worldwide on knee surgery, and has edited several textbooks, including, “Sports Medicine: Principle of Primary Care,” “MIS of the Hip and Knee” and “Surgical Techniques in Total Knee Arthroplasty.” Patients can call 516-801-8400 for an appointment.

About ISK

The Insall Scott Kelly® Institute is a full service orthopaedic center, comprised of a team of world-recognized orthopaedic surgeons, dedicated to serving the unique needs of the orthopaedic patient. Created in 1991 by Dr. John Insall, ISK is a specialized center which focuses on the treatment of orthopaedic and sports related ailments. ISK now offers three convenient locations in New York, including Garden City, Bay Shore and Manhattan.

http://www.iskinstitute.com

“If operated young soccer players return to play after just a few months, the risk of osteoarthritis development in the knee will increase in the long term” says researcher Richard Frobell. He addresses ACL injuries in a new thesis from Lund University in Sweden.

Richard Frobell studied cruciate ligament injuries with a magnetic resonance camera (MR), a technique that is not usually applied in these contexts. The camera images show that the ligament injury in the knee joint as such is only part of the problem. Most of the patients also had, besides meniscus injuries, fractures and bone marrow lesions, that is, damage to the porous bone and bleeding in the bone marrow.

“This is new to the research society. A common belief is to treat these injuries as largely affecting the cruciate ligament only, something that could be reconstructed using a muscle tendon, and the patient would be fine,” says Richard Frobell.

But operating can in fact make the knee worse. The MR study shows that knees that were operated on evinced still swollen joints, bone marrow damage, and cartilage changes one year after the original injury more often than knees that had not been operated on.

“Some athletes return very early to sports despite the fact that they have these types of complaints. Returning to sports early is often considered as a sign of a successful operation. But the risk of these people developing osteoarthritis in the future may have increased,” says Richard Frobell. Arthritis researchers have long been aware of the link between knee injuries and arthritis. The fact that injured players nevertheless go back to soccer is due to the fact that arthritis research has not been able to make an impact on sports medicine: to some extent they inhabit two separate medical worlds.

Richard Frobell also claims that knees with damaged anterior cruciate ligaments should not be operated on in early stages.

“Unless there is clear evidence that an operation is necessary, it’s better to wait and see what structured rehabilitation can achieve. This is what we usually do in southern Sweden, with good results. Elsewhere there seems to be an exaggerated believe in surgical treatment, but this believe is not based on science,” he says.

The dissertation also shows that as many as every second anterior cruciate ligament injury remains undetected. MR technology, which can help reveal undiagnosed injuries, is not commonly used by emergency wards at orthopedic clinics, and the damage is not shown in a regular x-ray.

“If the right questions are not asked, the swollen knee is not detected, and if the knee is not aspirated to verify bleeding in the joint, these patients will all too often be dismissed as having a simple knee sprain,” says Richard Frobell. . He feels that every patient with a possible cruciate ligament injury should be referred to an experienced diagnostician, so that injuries will not be missed and grow worse.

The dissertation is titled Treatment and Outcome of Anterior Cruciate Ligament Injury: Truth or Consequences.

VETENSKAPSRADET (THE SWEDISH RESEARCH COUNCIL)
Regeringstgatan 56
103 78 Stockholm

http://www.vr.se

Published quarterly, Current Reviews in Musculoskeletal Medicine will be primarily composed of evidence-based review articles. In addition, special sections will present editorials from leading thinkers in the field discussing controversial topics as well as breaking news in musculoskeletal medicine. The entire spectrum of musculoskeletal care will be discussed, including initial evaluation, conservative management, surgical referral and the pros and cons of different surgical options. The editors-in-chief are Grant Cooper, MD, of the New York Presbyterian Hospital and University Hospitals of Columbia and Cornell and Joseph E. Herrera, DO, of the Mount Sinai School of Medicine, NY.

Frances Louie, Editor, Clinical Medicine, at Humana Press, said, “We are extremely excited to launch this important, cutting-edge journal with such outstanding editors and editorial board members. Along with our expanding book program in musculoskeletal medicine, Current Reviews in Musculoskeletal Medicine represents Humana’s deep commitment to providing musculoskeletal medicine physicians with the most comprehensive, state-of-the-art content possible.”

Current Reviews in Musculoskeletal Medicine will be published electronically and in print. It will be available free of charge on Springer’s online information platform http://www.springerlink.com/ until the end of 2009. Features will include fast, electronic publication in Online First™, as well as Cross Reference Linking and Table of Content Alerts. In addition, all potential authors have the option, via the Springer Open Choice™ program, of publishing their articles using the open access publishing model.

According to the National Institutes of Health’s Osteoporosis and Related Bone Diseases Natural Resource Center, the most common causes of secondary osteoporosis in men include low levels of testosterone (hypogonadism), alcohol abuse, smoking, gastrointestinal disease, hypercalciuria, and immobilization.

“The longer we live the more important bone health becomes,” says noted expert Warren Levy, PhD, president, and CEO of Unigene Laboratories, a company on the forefront of the search for effective new drugs for treatment of the condition. “Fortunately, early screening can help identify patients at risk for the disease and, if osteoporosis does develop, treatments are available.”

The most commonly prescribed of these treatments is a class of drugs known as bisphosphonates. Bisphosphonates are the active ingredient in widely prescribed osteoporosis medications such as Fosamax, Actonel and Boniva. “These medicines work by inhibiting the osteoclast cells that remove bone, thereby preserving bone,” explains Levy. “In some instances however, users of bisphosphonates have experienced conditions that suggest that the body may have lost the ability to repair and replace older or damaged bone, a normal function of osteoclasts. These conditions may include osteonecrosis of the jaw and the occurrence of sudden fractures that do not heal normally.”

Unigene Laboratories has developed a product that provides osteoporosis sufferers with a safe, effective treatment using a natural hormone with a proven thirty-year history. Unigene’s peptide-based nasally delivered osteoporosis treatment appears to pose few, if any, long-term health threats to users. It is available today in a prescription drug called Fortical from Upsher-Smith Laboratories. Unigene is also developing an oral version of the product.

According to Levy, the problem of male osteoporosis has recently been recognized as an important public health issue, particularly as rates of life expectancy continue to rise.

International Musculoskeletal Medicine, formerly the Journal of Orthopaedic Medicine, is undergoing an exciting re-launch which will introduce the Editorial Manager online submission and refereeing system; an updated journal design; and see the extension of the journal’s scope to include all aspects of musculoskeletal medicine, including manual therapy and manual medicine.

International Musculoskeletal Medicine publishes peer-reviewed research and review papers about pain and dysfunction in the musculoskeletal system. It wishes to encourage better treatment by improving the evidence base for best practice. To encourage better understanding of musculoskeletal pain and dysfunction, it publishes papers dealing with its causation and the mechanisms underlying chronicity as well as the mechanisms for obtaining satisfactory relief.

The Journal’s Editor, Dr Richard Ellis, of Wessex Rehabilitation District Hospital, Salisbury, UK, welcomes the new publishing agreement: “This is an exciting opportunity for International Musculoskeletal Medicine to widen its scope to a greater audience and develop the achievements of the Journal of Orthopaedic Medicine. We are looking forward to developing online access to ensure the journal is a vital resource for the healthcare community.”

Caitlin Meadows, Managing Editor of Maney’s healthcare titles, is also enthusiastic: “The re-launch of the journal brings it alongside the leading publications in the field of musculoskeletal medicine in disseminating vital current research to academics and the healthcare profession.”

International Musculoskeletal Medicine is important to all who are interested in the scientific basis for the best and most cost effective non-surgical relief of musculoskeletal pain, especially by manual, exercise and injection therapies whether from the medical, physiotherapy, osteopathic or chiropractic professions. For more information please visit http://www.maney.co.uk/journals/imm.

The journal will be added to the Maney Online Research E-journals collection in 2008, which includes the MORE Healthcare collection. This collection features peer-reviewed international healthcare titles, providing high quality, evidence-based and clinically-orientated research papers to professionals around the world.

The Society of Orthopaedic Medicine was formed in 1979 to promote the theory and practice of orthopaedic medicine in the accurate diagnosis of lesions of the musculoskeletal system, and a non-surgical method of treatment for soft tissue lesions. Membership consists of approximately 1700 doctors and physiotherapists. For more information please visit http://www.somed.org.

The British Institute of Musculoskeletal Medicine was formed in l992 by an amalgamation of the British Association of Manipulative Medicine and the Institute of Orthopaedic Medicine. It exists to promote education and research in the science and art of musculoskeletal medicine for the ultimate benefit of the public.

http://www.bimm.org.uk.

Maney Publishing was founded in 1900 and has offices in the UK in Leeds and London, and in North America. With a collection of more than 70 journals in materials science, the humanities, and healthcare, Maney is committed to publishing high-quality journals in print and electronic formats that are international in scope and peer-reviewed. Maney publishes extensively for learned societies, universities and professional bodies.