Medical Specialties Commons^™

Alpha-Synuclein Dysregulation In Systemic Pathophysiology Of Synucleinopathies, Hallie H. Dolin, Bowen Zhou, Robert W. Maitta

Faculty Scholarship

Alpha-synuclein (α-syn) has long been identified as the etiologic agent of multiple neurodegenerative diseases, the most common and well-known of which are Parkinson's disease (PD) and Lewy body dementia (LBD). While it is known that the pathophysiology of these synucleinopathies involves aggregation of improperly-folded α-syn, the mechanisms leading to its accumulation have not been fully identified. However, multiple pathways have been proposed, any or all of which may contribute to synucleinopathies. The role of α-syn in normal homeostasis and in other organ systems, especially the hematopoietic system, has been reported recently. Research within the last decade has shown that α-syn …

Being Well: Stories Of Coping And Resilience, Simiao Li-Sauerwine, Abbas Husain, Al'ai Alvarez, Gillian Baty, Manish Garg, Ryan Bodkin, Andy Grock, Marc Borenstein, Pamela Dyne

Journal of Wellness

Introduction: The approach to physician well-being has transformed from a focus on identification of distress to embracing a comprehensive model that values vulnerability, growth, self-compassion, and a sense of purpose and community in the profession. This manuscript, a collaborative effort by the Council of Residency Directors in Emergency Medicine Well-being Committee and the Society for Academic Emergency Medicine Wellness Committee, presents the personal narratives of academic emergency physicians during which they faced challenges and stressors, as well as supportive resources they found helpful. The scenarios are written by the individuals themselves as they experienced them.

Discussion: Through these shared and …

Consideration Of Patient Phenotypes In Geographic Atrophy Due To Age-Related Macular Degeneration, Rishi P Singh, Christina Y Weng, John W Kitchens, Jaclyn Quilantan, Roy Schwartz, Caroline R Baumal, Roger A Goldberg

Faculty, Staff and Students Publications

Geographic atrophy (GA) is a form of advanced age-related macular degeneration (AMD) affecting approximately 1 million people in the USA and 5 million globally. In this review, retinal imaging techniques used for diagnosis and monitoring progression of GA in AMD, and the risk factors associated with the development and progression of GA are summarised. To familiarise clinicians with common phenotypes of patients with GA, the clinical and imaging features that may lead to rapid progression of GA in various phenotypes are highlighted. With the recent US Food and Drug Administration approval of new GA treatments that reduce lesion growth, understanding …

Leveraging A Randomized Trial To Assess Relationships Between Transeptal Puncture, Brain Emboli, And Migraine Symptoms, Adi Elias, Roderick Tung, Edward P Gerstenfeld, Trisha F Hue, Feng Lin, Jing Cheng, J Peter Weiss, Wendy S Tzou, Henry Hsia, Ashkan Ehdaie, Daniel H Cooper, T Jared Bunch, Jeffrey Arkles, Babak Nazer, Adam Lee, Alexios Hadjis, Duy T Nguyen, Mihail G Chelu, Joshua D Moss, Jonathan C Hsu, Miguel Valderrábano, Prashant D Bhave, Gabrielle Montenegro, Anthony S Kim, William P Dillon, Gregory M Marcus

Faculty, Staff and Students Publications

Background: Catheter ablation procedures with transseptal punctures (usually for atrial fibrillation) are often associated with migraine-related visual auras, but the mechanism remains unknown. Whether this phenomenon is mediated by the creation of an atrial septal defect from transseptal puncture or by silent acute brain emboli detected on magnetic resonance imaging related to the procedure remains to be investigated.

Objective: This study aimed to evaluate whether randomization to a transseptal puncture during catheter ablation for ventricular arrhythmias is associated with postprocedural visual auras and assess the relationship between occipital and parietal lobes acute brain emboli and migraine-related visual auras.

Methods: In …

From Imaging To Computational Domains For Physics-Driven Molecular Biology Simulations: Hindered Diffusion In Platelet Masses, Catherine House, Ziyi Huang, Kaushik Shankar, Sandra Young, Meghan Roberts, Scott Diamond, Maurizio Tomaiuolo, Timothy Stalker, Lu Lu, Talid Sinno

Cardeza Foundation for Hematologic Research

When formed in vivo, murine hemostatic thrombi exhibit a heterogeneous architecture comprised of distinct regions of densely and sparsely packed platelets. In this study, we utilize high-resolution electron microscopy alongside machine learning and physics-based simulations to investigate how such clot microstructure impacts molecular diffusivity. We used Serial Block Face - Scanning Electron Microscopy (SBF-SEM) to image select volumes of hemostatic masses formed in a mouse jugular vein, producing high-resolution 2D images. Images were segmented using machine learning software (Cellpose), whose training was augmented by manually segmented images. The segmented images were then utilized as 2D computational domains for Lattice Kinetic …

Development And Validation Of A Novel Clinical Risk Score To Predict Hypoxaemia In Children With Pneumonia Using The Who Prepare Dataset, Rainer Tan, Arjun Chandna, Tim Colbourn, Shubhada Hooli, Carina King, Norman Lufesi, Eric D Mccollum, Charles Mwansambo, Joseph L Mathew, Clare L Cutland, Shabir A Madhi, Marta Nunes, Sudha Basnet, Tor A Strand, Kerry-Ann F O'Grady, Brad Gessner, Emmanuel Addo-Yobo, Noel Chisaka, Patricia Hibberd, Prakash M Jeena, Juan M Lozano, William B Maleod, Archana Patel, Donald M Thea, Ngoc Tuong Vy Nguyen, Marilla Lucero, Syed Mohammad Akram Uz Zaman, Shinjini Bhatnagar, Nitya Wadhwa, Rakesh Lodha, Satinder Aneja, Mathuram Santosham, Shally Awasthi, Ashish Bavdekar, Monidarin Chou, Pagbajabyn Nymadawa, Jean William Pape, Glaucia Paranhos-Baccala, Valentina S Picot, Mala Rakoto-Andrianarivelo, Vanessa Rouzier, Graciela Russomando, Mariam Sylla, Philippe Vanhems, Jianwei Wang, Romina Libster, Alexey W Clara, Fenella Beynon, Gillian Levine, Chris A Rees, Mark I Neuman, Shamim Qazi, Yasir Bin Nisar, World Health Organization Prepare Study Group

Faculty, Staff and Students Publications

Background: Hypoxaemia predicts mortality at all levels of care, and appropriate management can reduce preventable deaths. However, pulse oximetry and oxygen therapy remain inaccessible in many primary care health facilities. We aimed to develop and validate a simple risk score comprising commonly evaluated clinical features to predict hypoxaemia in 2-59-month-old children with pneumonia.

Methods: Data from seven studies conducted in five countries from the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) dataset were included. Readily available clinical features and demographic variables were used to develop a multivariable logistic regression model to predict hypoxemia (oxygen saturation < 90%) at presentation to care. The adjusted log coefficients were transformed to derive the PREPARE hypoxemia risk score and its diagnostic value was assessed in a held-out, temporal validation dataset. The model and risk score were analysed by evaluating the area under the receiver operating characteristic curve (AUC), sensitivity and specificity.

Results: We included 14 …

Convergent Reduction Of Olfactory Genes And Olfactory Bulb Size In Mammalian Species At Altitude, Allie M Graham, Elysia Saputra, Bogdan Kirilenko, Jason S Presnell, Arianna Harrington, Chad Huff, Michael Hiller, Nathan Clark

Faculty, Staff and Student Publications

The invasion of specialized ecological niches can cause drastic changes to selection regimes, resulting in genomic and phenotypic transformation.

Risk Of Pancreatic Cancer In Glycemically Defined New-Onset Diabetes: A Prospective Cohort Study, Suresh T Chari, Bechien Wu, Camden Lopez, Eva Lustigova, Qiaoling Chen, Stephen K Van Den Eeden, Amethyst D Leimpeter, William Fisher, Amy Wood, Ashley S Alexander, John Valenta, Santhi Swaroop Vege, Erin E Carlson, Kari G Rabe, Phil A Hart, Lu Qian, Ying-Qi Zhao, Nadia Yosuf, Lynn Matrisian, Barbara Kenner, Jo Ann Rinaudo, Anirban Maitra, Ziding Feng

Faculty, Staff and Student Publications

Background & aims: The increased 3-year incidence of pancreatic cancer after new-onset diabetes observed in retrospective studies needs prospective validation. It is unknown whether incidence varies by race and ethnicity.

Methods: In a prospective, observational study using active real-time surveillance of electronic health records, we identified 18,838 adults 50 years or older with glycemically defined new-onset diabetes (GNOD). In this interim analysis, we report 3-year Kaplan-Meier estimates of the proportion diagnosed with pancreatic cancer after GNOD (absolute incidence [95% CI]) and associated standardized incidence ratio (SIR) by race and ethnicity, overall 3-year incidence of pancreatic cancer adjusting for racial distribution …

Accounting For Competing Risks In The Assessment Of Prognostic Biomarkers' Discriminative Accuracy, Xinran Huang, Xinyang Jiang, Ruosha Li, Jing Ning

Faculty, Staff and Student Publications

The discriminative performance of biomarkers often changes over time and exhibits heterogeneity across subgroups defined by patient characteristics. Assessing how this performance varies with these factors is crucial for a comprehensive evaluation of biomarkers and to identify areas for improvement in sub-populations with poor performance. Additionally, the presence of competing risks complicates the assessment of discriminative performance. Ignoring competing risks can lead to misleading conclusions, as the biomarker's performance for the event of interest, such as disease onset, may be confounded by its performance for competing events, such as death. To address these challenges, we develop a regression model to …

Psychopharmacological Therapy Positively Modulates Disease Activity In Inflammatory Bowel Disease: A Systematic Review, Federica Di Vincenzo, Antonio Maria D'Onofrio, Angelo Del Gaudio, Elena Chiera, Gaspare Filippo Ferrajoli, Francesco Pesaresi, Alessio Simonetti, Marianna Mazza, Georgios Demetrios Kotzalidis, Mauro Pettorruso, Giovanni Martinotti, Loris Riccardo Lopetuso, Antonio Gasbarrini, Gabriele Sani, Gionata Fiorino, Franco Scaldaferri, Giovanni Camardese

Faculty, Staff and Students Publications

Depression, anxiety, and perceived stress are common comorbidities in patients with inflammatory bowel disease (IBD) and may negatively influence the disease course. Likewise, severe IBD may contribute to the development or worsening of psychiatric symptoms. Despite the established relevance of the gut-brain axis and frequent use of psychotropic medications in IBD patients, limited evidence exists regarding the effects of psychiatric treatments on gastrointestinal disease activity. Therefore, the aim of this systematic review is to evaluate the effectiveness of psychiatric therapies on gastrointestinal symptoms and disease activity in patients with IBD. The work was conducted in accordance with PRISMA guidelines. Searches …

The Articularis Genu As A Surrogate For Structural Determinants Of Peri-Articular Myopenia In Osteoarthritis, Davis Martin, José A.Cruz Ayala, Mary C. Gatterer, Tara Soria, Ryan Schroeder, Vinod Dasa, Luis Marrero

School of Medicine Faculty Publications

The functional limitations associated with the painful stiffness of knee osteoarthritis (kOA) can affect the muscles of the knee, such as the quadriceps femoris (QF) and articularis genu (AG). The vastus medialis oblique (VMO) of the QF complex is particularly sensitive to kOA. The AG, which can be sampled during total knee arthroplasty (TKA) for kOA, can provide information about the condition of the QF when affected by patient-reported disuse, helping to identify indicators of muscle weakness in the synovial fluid. This study compares the structural and gene expression changes between the VMO and the AG collected from patients with …

Dopamine Partial Agonists In Pregnancy And Lactation: A Systematic Review, Alexia Koukopoulos, Delfina Janiri, Miriam Milintenda, Sara Barbonetti, Georgios D Kotzalidis, Tommaso Callovini, Lorenzo Moccia, Silvia Montanari, Marianna Mazza, Lucio Rinaldi, Alessio Simonetti, Mario Pinto, Giovanni Camardese, Gabriele Sani

Faculty, Staff and Students Publications

Background/Objectives: Dopamine partial agonists are drugs initially developed to treat schizophrenia, seeking a double effect of increased dopaminergic transmission in the prefrontal cortex and decrease in the accumbens/striatum. Of these drugs, aripiprazole, brexpiprazole, and cariprazine are currently marketed and used in schizophrenia spectrum and mood disorders. It is debated whether patients with psychiatric disorders becoming pregnant should discontinue or continue their antipsychotic treatment despite some risks for the fetus, i.e., whether it is worse to have an untreated disorder or treating it with drugs. The safety of drugs for mother and baby extend from pregnancy to the postpartum, when …

A Rare Cause Of Severe Bleeding In Neonate: Congenital Afibrogenemia Case Report, Abdul Azeem Hulkoti, Qudsiya Ansari, Kailas Randad, Akash Dnyandeo Sarkate Dr

Digital Journal of Clinical Medicine

Background- Congenital afibrinogenemia is a rare autosomal recessive disorder characterized by the complete absence of fibrinogen, a critical factor for clot formation in the blood. This deficiency leads to significant bleeding tendencies from birth. Patients typically present with severe haemorrhagic symptoms early in the neonatal period.

Case presentation- We describe a case of a neonate presenting with umbilical bleeding diagnosed with congenital afibrinogenemia. Initial clinical manifestations included active umbilical bleeding and pallor, while hematological workup revealed a lack of detectable fibrinogen. The diagnosis was confirmed by coagulation assays and genetic testing. The infant was managed with Fresh Frozen Plasma (FFP) …

Pan-Cancer, Multi-Omic Correlates Of Survival Transcending Tumor Lineage Across 11,019 Patients Reveal Targets And Pathways, Yiqun Zhang, Fengju Chen, Chad J Creighton

Faculty, Staff and Students Publications

Molecular correlates of cancer patient overall survival (OS) can provide new insights. Here, we systematically cataloged pan-cancer, multi-omic correlates of OS transcending tumor lineage across 11,019 patients, involving multiple cancer types while correcting for cancer-type-intrinsic OS differences. Significant fractions of genes with mRNA associated with OS in pan-cancer analyses showed concordant associations at the levels of DNA copy number alteration or methylation. Pan-cancer gene signatures of T-cell and macrophage tumor infiltrates were associated with better and worse OS, respectively. Pathways implicated by molecular OS associations included metabolism, PI3K/Akt, Wnt, and TGF-beta receptor. Significant fractions of worse OS-associated genes were essential …

Preliminary Investigation Of The Association Between Epigenetic Aging Acceleration And Amyloid Biomarkers In Bipolar Disorder, Gabriel R Fries, Steven De La Garza, Ning O Zhao, Andres W Bass, Camila N C Lima, Nobuhide Kobori, Tatiana Barichello, Gustavo Turecki, Paul E Schulz, Breno S Diniz, Jair C Soares

Faculty, Staff and Student Publications

Objectives: Bipolar disorder (BD) has been associated with an elevated risk of Alzheimer's Disease (AD). We assessed AD biomarkers in BD and tested whether epigenetic aging (EA) acceleration is associated with changes in these markers.

Design, setting, participants: Cross-sectional study of n = 58 living individuals with BD and n = 20 age- and sex-matched control participants, as well as analyses of postmortem brain samples (Brodmann area 9/46) from n = 46 individuals with BD.

Measurements: Amyloid beta (Aβ)40, Aβ42, and total Tau levels were measured in plasma from individuals with BD and controls, and Aβ42 levels were measured in …

Disseminated Diaper Dermatitis With Concomitant Body Rash: A Case Report., Catherine F Alapatt, Eileen Condren, Tanya Kadrmas-Iannuzzi

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Diaper dermatitis is a rash typically localized to the genital area and may have various etiologies, including irritant and allergic contact dermatitis. In most cases, it resolves on its own with minimal to no medical intervention, and when treatment is necessary, it usually responds promptly. Here, we present a prolonged case of diaper dermatitis accompanied by a nearly full-body rash that was resistant to initial treatment with steroids, antibiotics, and antifungals.

Mesenchymal Stem Cell-Derived Extracellular Vesicles: Seeking Into Cell-Free Therapies For Bone-Affected Lysosomal Storage Disorders, Andrés Felipe Leal, Harry Pachajoa, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Lysosomal storage disorders (LSDs) constitute a group of monogenic systemic diseases resulting from deficiencies in specific lysosomal enzymes that cause the intralysosomal accumulation of non- or partially degraded substrates, leading to lysosomal dysfunction. In some cases of LSDs, the bone is more severely affected, thus producing skeletal manifestations in patients. Current therapies, such as enzyme replacement therapy (ERT) and gene therapy (GT), show limited efficacy in correcting skeletal abnormalities. Increasing evidence suggests that microenvironmental disturbances also contribute significantly to disease pathogenesis. Therefore, therapeutic strategies targeting lysosomal dysfunction and microenvironmental dysregulation are needed. Mesenchymal stem-cell-derived extracellular vesicles (MSC-EVs) are emerging as …

Mic: A Deep Learning Tool For Assigning Ions And Waters In Cryo-Em And Crystal Structures, Laura Shub, Wenjin Liu, Georgios Skiniotis, Michael J Keiser, Michael J Robertson

Faculty, Staff and Students Publications

At sufficiently high resolution, x-ray crystallography and cryogenic electron microscopy are capable of resolving small spherical map features corresponding to either water or ions. Correct classification of these sites provides crucial insight for understanding structure and function as well as guiding downstream design tasks, including structure-based drug discovery and de novo biomolecule design. However, direct identification of these sites from experimental data can prove challenging, and existing empirical approaches leveraging the local environment can only characterize limited ion types. We present a representation of chemical environments using interaction fingerprints and develop a machine learning model to predict the identity of …

Human Extravillous Trophoblasts Require Src-2 For Sustained Viability, Migration, And Invasion, Vineet K Maurya, Pooja Popli, Bryan C Nikolai, David M Lonard, Ramakrishna Kommagani, Bert W O'Malley, John P Lydon

Faculty, Staff and Students Publications

Defective placentation is a recognized etiology for several gestational complications that include early pregnancy loss, preeclampsia, and intrauterine growth restriction. Sustained viability, migration, and invasion are essential cellular properties for embryonic extravillous trophoblasts to execute their roles in placental development and function, while derailment of these cellular processes is linked to placental disorders. Although the cellular functions of extravillous trophoblasts are well recognized, our understanding of the pivotal molecular determinants of these functions is incomplete. Using the HTR-8/SVneo immortalized human extravillous trophoblast cell line, we report that steroid receptor coactivator-2 (SRC-2), a coregulator of transcription factor-mediated gene expression, is essential …

Improving Genetics Equity: Identifying Women Eligible For Genetic Care Services Using Mammography Clinics In Underserved Areas As Screening Hubs, Darya Kizub, Rachel Bluebond, Sierra Green, Jessica Duckworth, Sreejesh Shanker, Autumn Vara, Banu Arun

Faculty, Staff and Student Publications

PURPOSE: Fewer than 20% of underserved individuals undergo guideline-concordant hereditary breast and ovarian cancer (HBOC) genetic testing (GT). Our study aimed to determine the proportion of women eligible for HBOC GT using a cancer genetics risk assessment (CGRA) tool at breast cancer (BC) screening clinics in underserved communities and to describe the program's impact.

METHODS: Participants were women who presented for BC screening at The Rose clinics, serving low-income underserved communities in southeast Texas, and completed the CGRA. High-risk individuals received bilingual educational materials and a saliva-based GT kit. Those with a pathogenic variant (PV) or a variant of uncertain …

Pan-Cancer Immune And Stromal Deconvolution Predicts Clinical Outcomes And Mutation Profiles, Bhavneet Bhinder, Verena Friedl, Sunantha Sethuraman, Davide Risso, Kami E Chiotti, R Jay Mashl, Kyle P Ellrott, Jordan A Lee, Christopher K Wong, Kofi Gyan, Aditya Deshpande, Marcin Imielinski, Rohan Bareja, Josh Stuart, Myron Peto, Katherine A Hoadley, Alexander J Lazar, Andrew D Cherniack, Jingchun Zhu, Shaolong Cao, Mark Rubin, Wenyi Wang, Oliver F Bathe, Nicolas Robine, Li Ding, Peter W Laird, Wanding Zhou, Hui Shen, Vésteinn Thorsson, Jen Jen Yeh, Matthew H Bailey, Daniel Cui Zhou, Xianlu L Peng, Mary Goldman, Yongsheng Li, Anil Korkut, Nidhi Sahni, D Neil Hayes, Michael K A Mensah, Ina Felau, Anab Kemal, Samantha Caesar-Johnson, John A Demchok, Liming Yang, Martin L Ferguson, Roy Tarnuzzer, Zhining Wang, Jean C Zenklusen, Paul Spellman, Olivier Elemento

Faculty, Staff and Student Publications

Traditional gene expression deconvolution methods assess a limited number of cell types, therefore do not capture the full complexity of the tumor microenvironment (TME). Here, we integrate nine deconvolution tools to assess 79 TME cell types in 10,592 tumors across 33 different cancer types, creating the most comprehensive analysis of the TME. In total, we found 41 patterns of immune infiltration and stroma profiles, identifying heterogeneous yet unique TME portraits for each cancer and several new findings. Our findings indicate that leukocytes play a major role in distinguishing various tumor types, and that a shared immune-rich TME cluster predicts better …

Vigorous Physical Activity As A Potential Environmental Risk Factor In Renal Medullary Carcinoma, Daniel D Shapiro, Sagar S Mukhida, Andrew W Hahn, Ayman Isahaku, Schyler M Turner, Jessica P Cheng, Pankaj K Chauhan, Susan S Thomas, Beei Chan, Zita D Lim, Nizar M Tannir, Maria Chang Swartz, Pavlos Msaouel

Faculty, Staff and Student Publications

Purpose: Renal medullary carcinoma (RMC) is a rare but aggressive kidney cancer affecting young individuals with sickle hemoglobinopathies. Prior retrospective case-control and mouse modeling studies suggest a mechanism linking vigorous intensity physical activity to increased RMC risk in individuals with sickle hemoglobinopathies. This study aimed to prospectively investigate the association between vigorous intensity exercise and RMC.

Materials and methods: This study used a validated questionnaire to prospectively assess reported physical activity in a large cohort of patients with RMC compared to the activity of individuals without RMC. Between 2022 and 2024, patients with RMC (N = 39) were prospectively surveyed …

Supporting Patients With Advanced Cancer And Their Spouses In Parenting Minor Children: Results Of A Randomized Controlled Trial, Kathrin Milbury, Sujin Ann-Yi, Meagan S Whisenant, Morgan Jones, Yisheng Li, Victoria Necroto, Sania D Yousuf, Mariana Chavez-Macgregor, Larrisa Meyers, Eduardo Bruera

Faculty, Staff and Student Publications

Introduction: Patients with advanced cancer and their spousal caregivers who parent minor children report unmet parenting concerns and increased psychological distress. Seeking to address these important supportive care needs, this RCT examined the feasibility, acceptability, and initial evidence for the efficacy of a novel psychosocial intervention.

Patients and methods: Patients with a metastatic solid malignancy and their spouses completed self-reported validated assessments of psychological symptoms and cancer-related parenting outcomes and were then randomized to the parent support intervention or a usual care (UC) group. Both groups were reassessed 6 and 12 weeks later. Dyads randomized to the counselor-led intervention attended …

Full Issue: Volume 3, Issue 1 - June 2025

Bone Bulletin

i - Editors’ Note

ii - Foreword by Dr. Alan Hilibrand

7 - Challenges and Concerns of Artificial Intelligence in Shoulder and Elbow by Claude J. Regis

10 - Exploring Robotic-Assisted Total Knee Arthroplasty by Sahil Shah

13 - The Future of Robot-Assisted Surgery in Foot and Ankle Procedures by Sam Duggan

16 - Revolutionizing Spine Surgery: The Potential Role of AI in Enhancing Surgical Workflow and Patient Outcomes by Samuel Ezeonu

21 - Management of Periprosthetic Humeral Fractures Following Shoulder Arthroplasty by Akshay Khanna

24 - Patient Specific Implants in Total Shoulder Arthroplasty by Alexander Zavitsanos

26 - Posterior …

Comparison Of Autograft, Allograft, And Conduits For Peripheral Upper Extremity Nerve Repair A Critical Review Of The Current State Of Bone Grafting In Orthopaedic Surgery, Samantha Meacock

Bone Bulletin

Introduction

Several mechanisms of injury can cause peripheral nerve injury (PNI) and subsequent impaired quality of life with loss of motor and/or sensory function. Trauma is a common cause of injury with the most commonly injured nerves being the radial (53%), ulnar (32%), and median nerves (15%).¹ The preferred treatment for PNI is reconnecting severed nerve ends anatomically with tension-free end-to-end direct nerve repair of healthy fascicles. However, if the nerve ends cannot be brought together without tension, gapping can occur, and a direct tension-less repair is not possible.⁵ In the case of a lengthy nerve gap, a …

A Critical Review Of The Current State Of Bone Grafting In Orthopaedic Surgery, Joseph Kelly

Bone Bulletin

Introduction

Millions of people around the world currently suffer from orthopaedic injuries and illness due to trauma, degenerative diseases, cancer, and infections that require bone grafting techniques to heal. Bone grafting allows a surgeon to replace missing, broken, or infected bone with a substitute that returns the structural integrity of the bone. Bone grafting can rebuild bones but can also help bones with existing defects to heal properly. There are multiple types of bone grafts, and each may be indicated in different scenarios to optimize healing, restore function, and prevent complications depending on the bone in question. The three broad …

Distal Radius Fractures: A Common Injury With Disproportionate Results, Brady Stillman

Bone Bulletin

Introduction

A distal radius fracture (DRF) is a common upper-extremity injury that occurs when the radius is fractured near the wrist, usually after falling on an outstretched or flexed hand. DRFs account for one-sixth of fracture-related emergency department visits.² In a 2009 study, a sample of 87 million Americans with upper-extremity fractures revealed the most common fracture sites were the distal radius and ulna.³ The distal radius was the most common fracture site in patients younger than 18 and older than 49, and the incidence is increasing in older adulthood.^{3, 4} A DRF can be classified as …

Innovative Pain Management Protocols In Orthopedics And Their Role In Reducing Postoperative Opioid Use, Jake Lamonaca

Bone Bulletin

Background

The opioid epidemic has emerged as one of the most pressing public health challenges of our time, marked by significant increases in opioid-related dependence, abuse, and death in recent years. Excess prescription of opioids represents a major contributing factor to this crisis.¹ The origins and impact of the opioid epidemic in the United States are documented in Sam Quinones research narrative, Dreamland. He highlights how pharmaceutical companies leveraged misinterpreted research—particularly a 1980 letter published in The New England Journal of Medicine suggesting a low risk of addiction associated with opioids—to normalize their widespread prescription. This flawed evidence served …

Analyzing The Common Criteria And Decision-Making Process For Opting Between Same-Day And Overnight Surgeries For Improved Patient Management, Gaston Davis

Bone Bulletin

Introduction

Within the scope of sports medicine, the decision to opt for same-day or overnight surgeries is multifactorial and relies on many interplaying considerations. Common factors include patient health, surgical complexity, and post-operative care requirements. This article explores the criteria and decision-making process involved in choosing between these two surgical options for common sports-related injuries, such as shoulder, elbow, hand, hip, knee, and ankle injuries.

Posterior Shoulder Dislocations In The Setting Of Seizures, Alex Charlton

Bone Bulletin

The shoulder joint provides an exceptional range of motion that allows for flexion, extension, adduction, abduction, internal rotation, external rotation, and 360-degree circumduction; however, this mobility comes at the expense of decreased stability.¹ Shoulder dislocations account for 50% of all joint dislocations, with anterior dislocation being the most common and usually associated with trauma.² In comparison, about 2-5% of shoulder dislocations are posterior and are often associated with more unique etiologies.¹ One of the most interesting resulting from a tonic seizure in an individual with epilepsy.