Philadelphia College of Osteopathic Medicine
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Autologous Fat Grafting of the Periorbital and Midface Areas.
No full textAutologous fat grafting to the midface and periorbital regions offers a powerful solution for addressing age-related facial volume descent and depletion, contributing to a rejuvenated appearance. Herein, we explore the biological principles of fat grafting, the methodology for harvesting, processing, and injecting fat, and its application in facial aesthetics. We describe the role of different types of autologous fat in restoring volume and improving skin texture and quality. Finally, we discuss the evolving techniques aimed at enhancing graft retention and aesthetic outcomes with a focus on the midface and periorbital regions
Comparison of outcomes after MPFL reconstruction in adult vs pediatric populations: A systematic review of the literature
No full textPurpose The purpose of this study is to compare the outcomes of medial patellofemoral ligament (MPFL) reconstruction in pediatric and adult populations. We hypothesize that pediatric patients will have poorer outcomes compared to adults. Methods PubMed, CINAHL, and EMBASE were queried using search terms relevant to MPFL reconstruction in pediatric and adult populations. Results were screened by title, abstract, and full text by two independent reviewers to determine inclusion eligibility. Articles with a total sample size \u3e30 and a minimum follow-up of \u3e2 years that reported on individuals \u3c 18 or \u3e18 years of age with recurrent patellar dislocations treated with isolated MPFL reconstruction were eligible for inclusion. Data on patient-reported outcome scores, recurrent instability rates, and complications were extracted for analysis. Results Eight studies met inclusion criteria and yielded data on 282 MPFL reconstructions. The average age of patients was 14.9 years for pediatric studies and 25.4 years for adults. The average follow-up was 49.04 months. No adults experienced additional dislocation events post-operatively, while 8/90 (8.9 %) of pediatric patients reported recurrent instability. Post-operative Lysholm scores were similar between populations (90.8 in adult, 89.8 in pediatric). Pediatric postoperative Kujala scores were 7.5 % lower than adult postoperative scores, reflecting greater pain and disability (91.2 in adult, 84.4 in pediatric). Two pediatric studies reported stiffness in 10/55 (18.2 %) of patients, while all adult studies reported full restoration of motion. Conclusion MPFL reconstruction results in good outcomes in both pediatric and adult populations with patellar instability. Recurrent instability, stiffness, lower return to sport, and worse patient-reported outcomes were more prevalent in pediatric populations. Future studies should account for this discrepancy and consider studying these groups separately or performing subgroup analyses to better understand outcomes
GRWD1 inhibits nucleolar stress and reduces the sensitivity of hepatocellular carcinoma to oxaliplatin.
No full textNo abstract availabl
Assessing reliable change, MCID, treatment response, and remission using the Pediatric Anxiety Rating Scale (PARS) in youth with anxiety disorders.
No full textYouth anxiety disorders are common and heterogeneous. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered tool designed to assess overall anxiety severity, independent of specific symptoms. The thresholds on PARS for the reliable change index (RCI), the minimal clinically important difference (MCID), treatment response, and full and partial remission remain unclear. Using the Clinical Global Impression (CGI) scales and diagnostic interviews as benchmark measures, several thresholds for the 6-item PARS were estimated using data from 904 youth with anxiety disorders, of which 36 % had an autism diagnosis. Data were drawn from 9 clinical trials conducted in the United States. Threshold accuracy was evaluated in a holdout sample and in an independent Swedish sample (n = 49). The reliable change index (RCI) was 3.39 points. A raw score reduction of ≥ 4 points or a ≥ 20 % reduction best defined the MCID. A raw score reduction of ≥ 8 points or a ≥ 43 % reduction best defined treatment response. Scores of 0-10 after treatment accurately defined full and partial remission, and scores of 0-5 defined full remission. Threshold accuracies ranged from 74-91 % in the holdout and 67-78 % in the Swedish sample. Treatment response accuracy was similar across samples, while MCID accuracy was lower in the Swedish sample. Similar cutoffs emerged in youth with and without autism and across age groups and genders. Threshold accuracies for the 5- and 7-item PARS versions were comparable to the 6-item version. This study establishes response and remission thresholds for PARS that are applicable across age groups, genders, and autism status. We advise against using the RCI as it does not exceed the MCID
Incidence and Risk Factors of Developing a Dysrhythmia After Blunt Thoracic Trauma.
No full textBackground/Objectives: The incidence of dysrhythmia after blunt thoracic trauma varies in the literature from 8-75%, and the complication rate from these dysrhythmias is not well studied. The aims of this study are to (1) identify the incidence of dysrhythmia following blunt thoracic trauma, (2) identify risk factors associated with developing a dysrhythmia, and (3) identify the incidence of cardiac intervention after developing a dysrhythmia. We hypothesize that blunt thoracic trauma may result in post-injury dysrhythmias. Methods: This is a retrospective review of trauma patients ≥ 18 years with a blunt mechanism of injury at a Level 1 Trauma Center from 1/2010 to 3/2022. Patients were included if they had one of the following: rib fracture, sternal fracture, chest wall contusion, pneumothorax, hemothorax, chest pain, chest wall deformity, or chest wall crepitus. Patients were excluded if they had an Abbreviated Injury Scale Chest = 0 or if they had a pre-existing dysrhythmia. Univariate, multivariate, and multivariable statistical analyses were performed. Results: In total, 2943 patients met inclusion criteria. In total, 574 (19.5%) developed a dysrhythmia; 100 (17.4%) required a new antiarrhythmic at discharge. Patients who developed a dysrhythmia had a nearly two times greater likelihood of requiring cardiac intervention than those without a dysrhythmia (AOR: 1.79; p = 0.004). Additional risk factors for requiring cardiac intervention included Injury Severity Score (ISS) 16-25 and \u3e25 (p \u3c 0.001). Conclusions: The incidence of dysrhythmia after blunt thoracic injury is 19.5% at our level I trauma center. Based on our study, patients that were older, had an ISS \u3e 25, had a history of previous cardiac disease, or required \u3e 5 units of blood products were at an increased risk of developing a dysrhythmia following trauma. As such, future consideration should be given to extended guidelines in monitoring these vulnerable patients
Malignancy-Associated Renal Infarction: A Case of Prostate Cancer Presenting With Flank Pain and Hematuria.
No full textRenal infarction is an uncommon but critical diagnosis that is frequently overlooked due to its nonspecific presentation and overlap with more common causes of abdominal or flank pain. Patients with malignancy, including metastatic prostate cancer, are at increased risk of thromboembolic events due to the intrinsic hypercoagulable state promoted by cancer, yet arterial events, such as renal infarction, remain underrecognized. We present the case of a 74-year-old male with metastatic castrate-sensitive prostate cancer who developed acute abdominal pain, nausea, and vomiting. Evaluation revealed elevated blood pressure, microscopic hematuria, and increased lactate dehydrogenase (LDH). CT scan of the abdomen and pelvis with contrast demonstrated wedge-shaped perfusion defects in the left kidney, consistent with renal infarction, allowing for the timely initiation of anticoagulation. This case underscores the importance of recognizing renal infarction as a potential complication of malignancy-associated thrombophilia. The classic triad of flank pain, hematuria, and elevated LDH should raise clinical suspicion, prompting early cross-sectional imaging to facilitate diagnosis and prevent irreversible renal injury
Paracentral Acute Middle Maculopathy After Sinus Surgery: A Case Report and Literature Review.
No full textPurpose: Herein, we describe a case of paracentral acute middle maculopathy occurring after routine sinus surgery. Methods: A single case was evaluated. Results: The patient presented with an inferocentral scotoma in the left eye 2 days after an uneventful sinuplasty procedure performed under local anesthesia. Examination and optical coherence tomography demonstrated paracentral acute middle maculopathy. A complete workup and urgent stroke evaluation revealed no clear underlying etiology. Conclusion: Sinus procedures may rarely be associated with paracentral acute middle maculopathy, possibly due to the vasoconstrictive effects of local anesthetics. Ophthalmologists and head and neck surgeons should be aware of this potential complication
Keynote: How hair made the sweaty ape naked
No full textYana Kamberov is an Associate Professor in the Department of Genetics at the Perelman School of Medicine where she leads a program to uncover the genetic mechanisms underlying the generation of adaptive human traits that not only differentiate humans from other species but are also essential for human survival. Accordingly, research in the Kamberov lab is focused on the etiology and regeneration of adaptive traits of the skin, which harbors some of the most extreme and physiologically important evolutionary adaptations of our species. Herein, the lab seeks to discover how, when, and why these traits evolved, and to apply this knowledge in the development of therapeutic strategies to regenerate human skin and its critical appendages.
Dr. Kamberov is a graduate of the University of Pennsylvania from which she received her Bachelor’s degrees in Biology and Anthropology. She received her Ph.D. in Cell and Developmental Biology from Harvard University. Prior to joining the Penn faculty, Yana was a postdoctoral fellow in the laboratory of Dr. Cliff Tabin at Harvard Medical School, with co-mentors Dr. Pardis Sabeti, Dr. Dan Lieberman, and Dr. Bruce Morgan. Her postdoctoral work focused on the genetic drivers of natural and adaptive variation in skin appendage phenotypes within modern humans and within genetically diverged mouse strains
A descriptive analysis of the demographic and pathological variations in pelvic lymph nodes: the impact of gender, age, and cancer status
No full textIntroduction
The lymphatic system is integrally involved in one’s immune function and fluid balance. Lymph nodes (LN), which are lined with immune cells, are responsible for filtering lymphatic fluid and returning volume to the veins. While LN involvement in disease is well studied, physiological variations by gender, age, BMI, and cancer status remain underexplored. Prior research suggests hormonal and anatomical factors may influence lymphatic structure. Additionally, while aging is linked to immune changes, its effect on LN morphology is uncertain.
This study examines whether gender, age, BMI, and cancer status impact LN count and surface area in the pelvic region. The null hypothesis was that there would be no gender, age, BMI, or cancer-related differences in the LNs in the inguinal region.
Methods
This retrospective study analyzed pelvic LNs from 109 cadavers (2019–2023) at PCOM-Georgia. Lymph nodes were counted and measured during dissection. This data along with demographic data (age, sex, race, and cause of death) were recorded in Excel and utilized in data analysis. Statistical methods: Surface area and count were analyzed using Mann-Whitney U, correlation analysis, and ANOVA to assess gender, age, BMI, and cancer-related differences in lymphatic structure.
Results
There was a statistically significant difference in LN count (p = 0.015) between males and females in the deep inguinal region, suggesting females have more nodes. However, other regions (superficial inguinal, iliac, lumbar, sacral) showed no significant variation in LN count or size by gender.
Age-related analysis (ANOVA) found no significant differences in lymph node count or surface area across all examined age groups (40-70, 71-90, \u3e91), suggesting aging does not significantly impact pelvic lymph nodes. BMI showed minimal correlation with LN count (0.041) and size (-0.066).
When analyzing cancer vs. non-cancer, LN data was not normally distributed. Therefore, the Mann-Whitney U test was utilized and showed no significant cancer-related differences in surface area (p=0.260) or number of LN (p=0.1645) for both males and females.
Discussion
The deep inguinal region exhibited significant gender-based differences in LN count, aligning with prior findings on hormonal and anatomical influences. This region is a key lymphatic drainage site, making it susceptible to gender-related variations in immune response and fat distribution. However, the absence of differences in superficial LNs suggests gender does not broadly impact the lymphatic systems in the inguinal region.
Aging did not significantly affect LN size-related morphology, contradicting some studies suggesting lymphatic atrophy with age. No significant cancer-related or BMI differences were observed, but data limitations—including small sample sizes and distribution imbalances—may have impacted results.
Our findings expand on Damineni’s 2022 study, which reported gender-based LN surface area differences in superficial and deep inguinal regions. Since the study in 2022 we have expanded the dataset from 39 to 109 cadavers which may have added to the variability in the data. Non-parametric statistical analyses were run to account for the unequal variance in data
Use of bacteriophages for recalcitrant Pseudomonas aeruginosa periprosthetic joint infection
No full textINTRODUCTION
Periprosthetic Joint Infection (PJI) is the most common cause of revision in total knee arthroplasty. Multidrug-resistant (MDR) Pseudomonas aeruginosa PJI is challenging as conventional antibiotic treatments are often ineffective and biofilm formation is prevalent.
Lytic bacteriophages are a relatively untouched treatment with the potential to be an effective therapy in these difficult to treat infections. This study assesses bacteriophage therapy to establish clinical control of a chronic multidrug-resistant (MDR) P.aeruginosa PJI.
METHODS
Prospective study of a patient who presented with a chronic multidrug resistant pseudomonas infection of an ipsilateral hip and knee PJI was performed. After multiple failed surgical and medical interventions, they were placed on palliative care. With FDA expanded access, two separate bacteriophages, PASA16 and Φ83, were injected into the knee and hip 9 times over 26 months.
These bacteriophages were further studied using a C.elegans model. C.elegans were infected with the patient’s clinical isolates of P.aeruginosa followed by phage treatment. Multiple different strains of P.aeruginosa were given with subsequent phage administration, and survival rates were compared to an untreated control group.
To investigate potential phenotypic changes before and after phage therapy, we further characterized P.aeruginosa clinical isolates and biofilm formation. Inhibition and eradication assays were performed with concurrent incubation with Φ83 and PASA16 bacteriophages. These incubations were compared to untreated control P.aeruginosa and examined for biofilm formation.
RESULTS
In a noted improvement to pre-therapy, Clinical control of PJI was maintained on ~3 month injections of Φ83 and PASA16 into joint spaces. The patient continued to culture MDR P.aeruginosa on aspiration cultures, but displayed no clinical or laboratory infectious symptoms.
In the C.elegans model, significant survival increases were seen with all strains of patient cultured P.aeruginosa inoculated C.elegans treated with Φ83 and PASA16 therapy compared to untreated groups. S1 strain (obtained pre-phage-therapy) had 7 day survival rates of 66% and 86% with PASA16 and Φ83, respectively, compared to 13% untreated C.elegans. S8 (obtained during phage-therapy) treated with combined PASA16 and Φ83 post-infection had 86% survival compared to 6.2% untreated with phage. All C.elegans trials (6 P. aeruginosa strains) exhibited significantly improved survival after phage administration.
Biofilm analysis presented significantly reduced biofilm production with phage therapy compared to untreated. Significant biofilm reduction was exhibited with patient-derived pre-phage-treated P.aeruginosa, mid-treatment samples, and post-treatment samples. Additionally, after allowing biofilm to form uninhibited for 48h, treatment with phage therapy exhibited significant biofilm eradication with every stage of patient-derived P.aeruginosa. This quantitative analysis was verified with qualitative analysis through photographic review, further supporting the decrease in biofilm.
DISCUSSION and CONCLUSION
After treatment with PASA16 and Φ83, the study patient exhibited clinical recovery from a chronic PJI unresponsive to prior interventions. Significant survival increases were shown in the C.elegans Kaplan-Meier survival analysis. Additionally, significant reduction in biofilm production, a natural hurdle to PJI infections, was seen in P.aeruginosa strains treated with PASA16 and Φ83. This study emphasizes the potential of bacteriophage therapy in combating PJI and provides valuable insights into biofilm-related mechanisms