Philadelphia College of Osteopathic Medicine
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Lymphoscintigraphy use and surgical planning in patients with recurrent ipsilateral breast cancer
Full text linkBackground/Objective:
In recent literature, there has been a question of how to surgically manage patients with recurrent ipsilateral breast cancer due to the possibility of aberrant lymphatic drainage pattern secondary to a previous axillary lymph node dissection. The use of preoperative lymphoscintigraphy to map possible aberrant drainage patterns prior to surgery remains investigational, necessitating the need for further management guidelines.
Methods:
We identified two patients in our database with recurrent ipsilateral breast cancer and previous nodal surgery as well as lymphoscintigraphy showing focal uptake of radioactive tracer on the contralateral side.
Results:
Two patients presented with recurrent ipsilateral breast cancer. A 66-year-old female diagnosed with right breast cancer in 2008. This patient underwent right lumpectomy with axillary lymph node dissection, chemotherapy and radiation therapy. She presented in 2024 with a new diagnosis of right invasive ductal carcinoma, grade 2, ER/PR positive, HER2 negative. The second patient is a 64-year-old female diagnosed with left breast cancer in 1998. This patient underwent left lumpectomy with axillary lymph node dissection, chemotherapy and radiation therapy. She presented in 2021 with a new diagnosis of left invasive ductal carcinoma, Grade 2, ER/PR positive, HER2 negative. Both patients underwent lymphoscintigraphy with radioactive tracer showing focal uptake on the contralateral side indicating aberrant lymphatic drainage. Our findings collectively suggest that in patients with recurrent ipsilateral breast cancer and previous SLNB and axillary node dissection, using nuclear medicine lymphoscintigraphy early in the treatment course offers essential information for surgical planning.
Conclusions:
Lymphoscintigraphy performed in patients with recurrent ipsilateral breast cancer could prove to be useful in providing information essential to breast cancer management. Using this technique, aberrant lymphatic drainage and potential nodal metastasis can be identified and used to inform surgical planning. There is a need for further management guidelines in patients with aberrant lymphatic drainage to the contralateral side with previous axillary lymph node dissection and possibly even sentinel lymph node biopsy
Lead Contamination Propagation into Plants of a Metro Atlanta Home
Full text linkINTRODUCTION: Lead pollution in residential areas of Metro Atlanta has spurred the EPA to increase efforts to remediate contaminated soil, resulting in the designation of the Westside Lead Atlanta, GA Superfund site. Lead poses significant risks to human health, interfering with vital biological functions, such as blocking important calcium-dependent pathways. Historic practices of lead-based industries with poor disposal procedures have caused local soil and water pollution. This is evident particularly along historical railroad routes used for transporting metal-laden industrial goods. The soil along these routes frequently exhibits heightened levels of heavy metals due to regular train activity, exacerbated by waste dumping along the routes. Notably, former railroad easements may evolve into residential areas, as evidenced by a home in Metro Atlanta situated north of the Superfund site. Tests conducted at this residence unveiled substantial lead contamination, particularly in areas where crops were grown. Consequently, the EPA established this resident as the Buckhead Slag Superfund site with remediation of local soil occurring in November 2023 to address the elevated lead levels and safeguard public health.
OBJECTIVES: This study aims to conduct soil and plant sample analysis for lead contamination in a Metro Atlanta residence with support from the Saikawa Lab of Emory University to observe for possible lead propagation in plants.
METHODS: Soil and plant samples were collected and prepared for lead contamination assessment using inductively coupled plasma mass spectrometry (ICP-MS). While lead naturally exists in soil at a concentration averaging 10-30 mg/kg, levels surpassing this range may suggest contamination from exogenous sources. The EPA originally had the conservative lead soil screening level (SSL) as 400 mg/kg for residential homes, but as of January 2024 this level has changed to 200 mg/kg, indicating a public health concern. If lead levels exceed this threshold, the EPA recommends further evaluation for possible soil remediation.
RESULTS: Additional samples were analyzed to extend the previous report. The results continue to demonstrate the propagation of lead from contaminated soil into local vegetation over time with an average level of 143.9 mg/kg, ranging from minimal levels of 5.1 mg/kg to significantly teratogenic levels of 499.5 mg/kg. Sample collection sites ranged from high-use areas near the home where the homeowner grew and consumed their own vegetables to areas downhill along the terraced garden within the property boundary.
CONCLUSION: Amid COVID-19, many turned to home or community gardens to supplement their food supply. Raising awareness about the risks of planting in untested areas is crucial to ensure safe backyard produce cultivation
Effectiveness of osteopathic manipulation therapies vs PT/rehabilitation therapies on multiple sclerosis symptoms
Full text linkIntroduction:
We review some of the epidemiologic and genetic aspects of Multiple Sclerosis (MS) while highlighting the benefits of an osteopathic approach to relieving symptoms and psychological distress in MS and similar disease states.
We focus on the efficacy of current PT/rehabilitation therapies versus Osteopathic Manipulative Therapies for selected symptoms in patients with MS, including changes in mood, motor functions, fatigue, vertigo, sleep, and chronic pain.
Living with MS is extremely expensive, ranging from an average per-person per-year cost of 18,542 for indirect costs/non-medical costs (Bebo et al., 2022). This study can be used to expand the utility of Osteopathic Manipulation Therapy to potentially serve as a quick, easy, and cost-effective adjunct therapy to alleviate symptom burden while reducing reliance on medications solely targeted for symptom management in patients living with MS.
Methods:
A literature search was conducted to review MS, OMT, and physical therapy/ rehabilitation therapy, as well as therapies used in other neurological conditions that may be applied to MS patients
Databases searched: PubMed, Clinical Key, De Gruyter, Google Scholar, Elsevier
Search terms (in combinations): multiple sclerosis, neurologic disease, OMT, Physical therapy, rehabilitation therapy, manual therapy, multiple sclerosis specific [symptom(s)]
Inclusion criteria were set wide due to limited research on the effectiveness of OMT and rehabilitation therapy in MS and other neurological diseases.
MS type: progressive and relapsing-remitting
Study designs: RCT, experimental, Reviews, one case report, international studies
Outcome measures: short- and long-term outcomes of OMT and physical therapy
Exclusion criteria: publications prior to 2000, publications not published in a peer-reviewed journal
Results:
Mood: PT (aerobic exercise and gait training but not clinical Pilates) had a significant improvement in mood, while all OMT studies showed significant improvements.
Motor functions: PT had a significant improvement in balance, mobility, and walkability but not spasticity. OMT had significant improvements in all categories in addition to weakness.
Fatigue: Both PT and OMT had significant improvements in fatigue.
Vertigo: There were specific maneuvers in PT for vertigo proven to be successful. OMT was found to be supportive but not proven to treat
Sleep: There are data supporting PT, however, evidence was mixed for OMT
Chronic pain: Both OMT and PT are helpful for chronic pain, however, more evidence supports OMT
Discussion:
The use of OMT as a complementary and alternative medicine to target symptomatic relief and enhance quality of life in all aspects for patients with MS is underexplored but shows promising data that it has a significant effect.
Potential Limitations: Not everyone is trained in Osteopathy, which limits access to OMT; various trials have fewer participants, and the power is not great.
Work must continue to unfold the inner workings of MS so that patients may have the best chance at slowing their progression, understanding how their disease developed, and having symptomatic relief
Development and Characterization of Hydrogel Microneedle Patch
Full text linkIntroduction: Levodopa, co-administered with the dopa decarboxylase inhibitor carbidopa, remains the gold standard for treating Parkinson\u27s Disease; however, due to rapid degradation, only about 1% of orally administered levodopa crosses the blood-brain barrier. Previously, this study explored a transdermal microneedle delivery system to enhance levodopa bioavailability by bypassing gastrointestinal metabolism. Microneedles penetrate the stratum corneum, reaching the dermis—rich in blood vessels—enabling direct systemic absorption and sustained drug release.
Objective: The focus of the experiment was to first develop a levodopa-containing transdermal cream combined with microneedles to enhance skin penetration and drug absorption. Transdermal delivery systems are expected to improve patient compliance by enabling continuous administration, thereby reducing “on-off” motor fluctuations and minimizing gastrointestinal side effects commonly associated with oral medications.
Methods: In this study we used deionized (DI) water, phosphate buffered saline, and an phosphate buffered saline at a pH of 5.91 to determine the solubility of levodopa. Once we determined solubility, stabilizing the drug without using carbidopa was necessary. Multiple antioxidant or antioxidant-like chemicals were used including ethylenediaminetetraacetic acid, ascorbic acid, sodium thiosulfate anhydrous, and glutamic acid hydrochloride. These compounds were tested visually over a 30-day period and quantified using high performance liquid chromatography(HPLC).
Formulations of the hydrogels were tested using the following base polymers: polyvinyl alcohol, polyethylene glycol, carboxymethyl-cellulose sodium, and poloxamer 407 NF. Some of these polymers required crosslinkers including calcium chloride and glutaraldehyde. Additionally, the use of synthetic or natural polymers, potentially in combination with cross linkers may help maintain the benefits of the transdermal microneedle delivery, while ensuring uniform drug suspension or dissolution.
Results: From the experiment we determined a solubility of 3.3 mg/mL of levodopa in phosphate buffered saline adjusted to a pH of 6. Over 30 days, we found that the stability of levodopa was best maintained by glutamic acid hydrochloride, as quantified by HPLC, which showed a decrease of 10% over a 10 day period.
The mobile phase of the HPLC analysis followed an isocratic method consisting of 95% monopotassium phosphate and 5% methanol, using a reversed-phase C18 column for the stationary phase with dimensions of 250 mm x 4.6 and 5-micron pores. The calibration standards for this method showed a linear regression of R2 = 0.9987.
Conclusion: We were able to develop an HPLC method to quantify the concentration of levodopa and determine its stability with added glutamic acid hydrochloride over a 10-day period. Although not a curative treatment, this optimized transdermal system aims to provide more consistent dopamine replacement to improve the management of Parkinson’s disease motor symptoms
Outcomes of endoscopic proximal hamstring repair: A systematic review
Full text linkBackground: As endoscopic techniques for proximal hamstring repair become increasingly popular, it is essential to evaluate the efficacy and safety of this method compared to traditional open repairs. This systematic review aims to evaluate the current literature on outcomes of endoscopic proximal hamstring repair (ePHR), focusing on functional outcomes, patient-reported outcomes, and complication rates.
Methods: A systematic search was conducted identifying six studies reporting on a total of 115 patients undergoing ePHR with a minimum follow up of 12 months. Data extracted included patient demographics, injury characteristics, surgical techniques, rehabilitation protocols, patient-reported outcomes (PROs), and complication rates. Patient-reported outcomes included measures such as the Modified Harris Hip Score (mHHS), Hip Outcome Score-Sport Specific Subscale (HOS-SS), and International Hip Outcome Tool (iHOT-12). Both comparative studies between endoscopic and open repairs as well as those focusing solely on endoscopic repair were included.
Results: Across the studies, endoscopic repairs showed significant improvements in PROs. iHOT-12 scores improved by an average of 46.3 points, with postoperative scores ranging from 81.9 to 87.2. The mHHS scores ranged from 89.6 to 90.6, indicating strong functional recovery, while the HOS-SS scores averaged 85.95. Return to sport outcomes were significant, with one study reporting a 100% return to organized sports and 72.2% to recreational activities within its cohort, while another study showed 94.7% of patients successfully returning to sport. Additionally, both studies observed a 100% return to work. Across four studies comparing endoscopic and open repairs, the average complication rate was 15.54% for endoscopic repairs and 23.8% for open repairs.
Conclusion: Endoscopic proximal hamstring repair demonstrates favorable outcomes, including high patient satisfaction, significant functional improvements, and low complication rates. Based on the available literature, the evidence supports its use as an effective treatment option for proximal hamstring injuries, offering comparable or superior results to open techniques with fewer complications. Further studies with larger patient sample sizes are needed to strengthen this evidence
Bridging healthcare disparities in Native American communities: the role of telemedicine in lung cancer screening and ophthalmic care.
Full text linkIntroduction
Native American populations experience significant healthcare disparities, particularly in lung cancer screening and ophthalmic care. Limited access to specialized medical services, geographic isolation, and socioeconomic barriers contribute to lower screening rates and higher disease burdens. Telemedicine offers a potential solution by bridging gaps in healthcare access and improving early detection and treatment. This study examines the effectiveness of telemedicine interventions in addressing these disparities.
Methods
A systematic literature review was conducted using PubMed, MEDLINE, Google Scholar, and Indian Health Service publications. Keywords included Native American health disparities, lung cancer screening, ophthalmic care, and telemedicine. Inclusion criteria focused on studies from the past 10–15 years, prioritizing systematic reviews, clinical trials, and observational studies specific to American Indian/Alaska Native (AI/AN) populations.
Results
Findings indicate that AI/AN individuals have disproportionately higher rates of lung cancer mortality and ophthalmic conditions such as diabetic retinopathy, cataracts, and glaucoma. Lung cancer screening rates remain the lowest among all racial and ethnic groups, contributing to late-stage diagnoses and poor outcomes. Telemedicine interventions, such as the Indian Health Service-Joslin Vision Network (IHS-JVN) for ophthalmic care and store-and-forward telehealth for lung cancer screening, have shown promise in increasing screening compliance and improving early detection rates. Mobile health units and community-integrated telehealth programs have also demonstrated success in expanding healthcare access in rural AI/AN communities.
Discussion
The integration of telemedicine into lung cancer and ophthalmic screening programs presents an opportunity to mitigate healthcare disparities in Native American communities. However, barriers such as digital literacy, internet availability, and cultural considerations must be addressed. Future research should focus on optimizing telehealth models tailored to AI/AN populations, ensuring cultural competence, and developing sustainable telemedicine infrastructures. Strengthening partnerships with tribal health organizations and incorporating community-led education initiatives can enhance the effectiveness and adoption of telehealth services.
Conclusion
Telemedicine represents a viable strategy to improve lung cancer screening and ophthalmic care among Native American populations. By addressing key barriers and leveraging culturally sensitive approaches, healthcare providers can enhance early detection, reduce mortality rates, and improve overall health outcomes in AI/AN communities
Addressing the effects of stress on menstrual cycle regularity and symptoms: A review of contributing factors, racial disparities, and lifestyle interventions
No full textIntroduction: Menstrual health is a critical aspect of overall well-being, yet many individuals experience cycle irregularities influenced by psychological and physiological stressors. Research suggests that both acute and chronic stressors can impact hormonal regulation, leading to menstrual disturbances. Despite growing evidence of this relationship, gaps remain in understanding the underlying mechanisms and effective interventions.
Objective: This literature review aims to examine the relationship between stress and menstrual irregularities by analyzing physiological mechanisms, psychological and lifestyle influences, and potential mitigation strategies.
Methods: A systematic review of peer-reviewed articles, clinical studies, and meta-analyses published in the past two decades was conducted using databases such as PubMed and Google Scholar. Studies focusing on human subjects of reproductive age were prioritized. Findings were categorized based on physiological mechanisms, psychological stressors, and lifestyle factors.
Results: Chronic stress is associated with menstrual irregularities due to dysregulation of the hypothalamic-pituitary-ovarian (HPO) axis. Elevated cortisol levels suppress gonadotropin-releasing hormone (GnRH), leading to disrupted follicular development, anovulation, and alterations in cycle length. Psychological factors such as anxiety and depression further contribute to menstrual disturbances, while lifestyle factors—including poor sleep, diet, and excessive workload—exacerbate stress-related dysfunctions. Findings suggest an increased prevalence of extended or shortened cycles, heightened premenstrual symptoms, and, in some cases, amenorrhea among individuals experiencing chronic stress.
Conclusion: The evidence strongly supports the link between stress and menstrual irregularities through neuroendocrine pathways. However, further research is needed to develop effective interventions for stress-induced menstrual dysfunction. Future studies should explore individualized stress management strategies, such as mindfulness, cognitive-behavioral therapy, and lifestyle modifications, to enhance menstrual health outcomes. Addressing these factors can provide valuable insights for healthcare providers in optimizing reproductive healthcare and promoting overall well-being
Some Like It Hot -Structural Changes in Extremophile Rubredoxin at 120 °C.
No full textHow does the structure of a protein change as the temperature is raised from cryogenic conditions at 100 K to 393 K? Understanding the structure and dynamics of proteins under environmental extremes is relevant for human health, biotechnological applications, and our search for life elsewhere in the universe. Here we reveal the high temperature crystal structure of a hyperthermophilic (Pyrococcus furiosus) rubredoxin at 393 K (120 °C), together with multiple complementary structures down to 100 K. The results are compared with molecular dynamics calculations. Significant changes in H-bonding are observed. Discussions about high-temperature protein structure and stability need to recognize that low temperature structures may not represent the high temperature case
Exploring the prevalence of gout among underrepresented low socioeconomic status type 2 diabetes populations.
Full text linkBACKGROUND: Underserved and underrepresented populations often lack access to affordable, quality healthcare, educational resources, and nutritious foods, all of which contribute to increased risk of Type 2 Diabetes and gout. Type 2 Diabetes is a condition characterized by the denaturation of the insulin receptors, due to chronically high blood glucose levels, leading to impaired regulation of blood sugar. Gout is a chronic inflammatory disease affecting joints in the lower limbs, marked by elevated serum urate levels and the accumulation of uric acid crystals in synovial fluid, causing painful flare-ups that significantly impact quality of life.
METHODS: This multisite cross-sectional study was conducted in three low-income senior residential communities across the mid-Atlantic United States, including Philadelphia and Harrisburg, Pennsylvania, and Clinton, Maryland. A total of 88 consenting participants were surveyed on their health history and tested for hemoglobin A1c (HbA1c), blood glucose, and uric acid levels using finger-stick blood tests and commercially available devices. Inclusion criteria included individuals of any gender, aged 35-92, residing in these communities. Exclusion criteria were a personal history of cancer, organ transplantation, or current pregnancy. Educational materials were provided after discussing each participant\u27s results.
RESULTS: There is an identifiable prevalence of gout among this population of low-income senior adults living with Type 2 Diabetes. Among the participants, 30.7% had serum urate levels indicative of hyperuricemia, exceeding the national average of 20.1% as reported by the National Health and Nutrition Examination Survey. Participants with high HbA1c had significantly higher uric acid levels compared to those with lower HbA1c levels, with diabetic levels of HbA1c accounting for approximately 40% of the variance in uric acid levels. Additionally, study participants who smoked cigarettes were more likely to have hyperuricemia than non-smokers.
CONCLUSION: Preventive educational efforts focused on diet and lifestyle are critical to reducing the incidence of gout and Type 2 Diabetes in low-income elderly populations. Diabetic individuals are at a higher risk of developing hyperuricemia and gout compared to non-diabetics. Community-based educational health programs are necessary to make a measurable impact on these populations, prevent disease progression, and reduce the burden on healthcare systems
A. T. Still\u27s “The Rule of Fluid, Nerve, Fascia, Muscle, and Bone”–An Investigation Beyond “The Rule of the Artery”
No full textThis article proposes an expanded version of Andrew Taylor Still’s “Rule of the Artery”, suggesting “A. T. Still’s ‘Rule of Fluid, Nerve, Fascia, Muscle, and Bone’ – An Investigation Beyond ‘Rule of the Artery.’” It describes A. T. Still’s description of the integrated role played by arterial, venous, lymphatic, cerebrospinal fluid, nerve, fascia, muscle, and bone aspects of each individual’s health