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Concomitant ACL avulsion fracture and patellar tendon injury: A Unique Combination of Injuries Treated with a Novel Approach in a Case Report
Get PDFThis case report describes a complex knee injury in a 16-year-old athlete after a football injury. The injury included a bucket-handle medial meniscus tear, anterior cruciate ligament (ACL) tibial avulsion fracture, patellar tendon avulsion, grade III medial collateral ligament (MCL) rupture, and lateral meniscus anterior root avulsion fracture. This combination of injuries presented as a unique case and operative procedure. The young athlete went on to return to sport, progressing to the division II level of play in college
Carpal Tunnel Dimensions Following Osteopathic Manipulation Utilizing Dorsal Carpal Arch Muscle Energy: A Pilot Study
Get PDFContext: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. When mild to moderate in severity, nonoperative treatments including osteopathic manipulative treatment (OMT) have been found to be effective. Studies have been carried out to quantify the mechanism of such treatments with cadaver studies, magnetic resonance imaging (MRI), and ultrasound.
Objectives: This pilot project investigated the mechanism of a previously undescribed technique of nonoperative carpal tunnel treatment, dorsal carpal arch muscle energy (DCA-ME), which focuses on the dorsal arch (trapezium, trapezoid, capitate, and hamate bones) manipulating the bones to redome the arch, round the tunnel, and increase its volume. Although the actual effectiveness of such manipulation in the treatment of CTS can only be assessed and quantified in patients with the disorder, this initial study was carried out to see if it was feasible for physical changes following DCA-ME to be quantified with ultrasound.
Methods: A pilot study of 25 healthy volunteers with no prior history of CTS or related disorders was undertaken to quantify anatomical changes in carpal tunnel dimensions following OMT of the nondominant wrist, utilizing DCA-ME. The subjects were randomly assigned to either the OMT group (n=14) or the control group (n=11). The control group underwent a sham manipulation. Pre- and postultrasound measurements of carpal tunnel dimensions were made. The study employed a two-group, pre-/postmanipulation design to evaluate the anatomical changes resulting from the OMT manipulation compared to those following the control sham manipulation.
Results: Comparison of the OMT and control groups revealed a mean increase in carpal tunnel depth from 0.45 mm ± 0.13 mm pre-OMT to 0.48 mm ± 0.13 mm post-OMT (p=0.0146, Cohen’s d=0.214, 95 % CI 0.0068 to 0.0517). There was also a mean increase in cross-sectional area from 1.83 mm2 ± 0.56 mm2 pre-OMT to 1.98 mm2 ± 0.59 mm2 post-OMT (p=0.0058, Cohen’s d=0.260, 95 % CI 0.0517 to 0.2490). There was no significant difference in canal width (p=0.5973) or transverse carpal ligament length (p=0.2673) following OMT intervention. The control group, which received the sham procedure, demonstrated no significant differences in the transverse carpal ligament length, carpal tunnel width, depth, or cross-sectional area before and after the sham intervention.
Conclusions: Ultrasound measurements at the narrowest section of the carpal tunnel before and after DCA-ME OMT of healthy asymptomatic wrists demonstrated a significant increase in cross-sectional area as well as depth, with no significant change in the length of the transverse carpal ligament, suggesting that the cause of the increased volume is an alteration of dorsal arch shape. A limitation of the study is the small sample size, inclusion of only healthy wrists, the short period of time between manipulation and measurements, and the difficulty of assuring the same level and angle of ultrasound measurements
GLP-1 Agonists are Protective Against Postoperative Complications Following Total Knee Arthroplasty
No full textBackground: Glucagon-like peptide-1 receptor agonists (GLP1RAs) have gained prominence for managing type 2 diabetes mellitus and obesity. Their impact in orthopedic surgery, particularly total knee arthroplasty (TKA), remains underexplored. Thus, this study aimed to investigate the influence of GLP1RAs on 90-day medical complications and 2-year surgical outcomes following TKA.
Methods: A retrospective cohort analysis was performed using a national all-payer claims database. Patients who underwent primary TKA were stratified into two groups: patients who received a GLP1RA within 6 months prior to surgery (GLP-1 cohort) and patients who did not have a GLP1RA history. Outcomes included the incidence of 90-day readmission and medical complications, and 2-year surgical complications. Univariate and multivariable regression analysis was conducted to compare outcomes.
Results: Patients in the GLP-1 cohort exhibited a lower 90-day readmission rate (OR: 0.77; P \u3c 0.001) and fewer medical complications such as arrhythmia (OR: 0.78), death (OR: 0.24), and deep vein thrombosis (OR: 0.70) compared to the control (P \u3c 0.05 for all). However, they experienced a higher odds of acute renal failure (OR: 1.16; P = 0.001). No significant differences were observed in 2-year surgical outcomes.
Conclusion: GLP1RAs use is associated with a reduced incidence of certain 90-day medical complications following TKA. We believe that this is likely due to their effects on weight loss and glycemic control. However, they are associated with an increased risk of acute renal failure. GLP1RAs do not appear to influence long-term surgical outcomes, suggesting their benefits are primarily confined to the early postoperative period
Addressing the Root Causes of Female Hair Loss and Non-Pharmaceutical Interventions
No full textFemale hair loss affects over 50% of postmenopausal women, with up to 40% of healthy women experiencing frontal/parietal hair loss, often beginning around reproductive age. Androgenetic alopecia is the most prevalent form of hair loss. Other types include alopecia areata, telogen effluvium, and scarring alopecias, such as lichen planopilaris and central centrifugal cicatricial alopecia. Hair loss can severely impact a woman\u27s psychological well-being, yet treatments approved by the US Food and Drug Administration (FDA) remain limited to topical minoxidil and oral Janus kinase inhibitors. This manuscript reviews the multifaceted causes of female hair loss, hormonal imbalances, inflammation, nutrient deficiencies, aging, and oxidative stress, and explores non-pharmaceutical interventions. Saw palmetto, horsetail, and pumpkin seed oil, all of which inhibit 5α-reductase, show promise in promoting hair density and reducing hair follicle miniaturization. Curcumin has demonstrated anti-inflammatory effects, contributing to improved hair and scalp health. Nutritional deficiencies, particularly in iron, vitamin D, and essential minerals, also play a significant role in hair loss, underscoring the importance of a balanced diet and conservative supplementation. Avoiding excessive supplementation, especially with biotin, is recommended due to potential diagnostic test interferences. With increasing demand for non-pharmaceutical options, identifying natural, safe, and effective treatments for female hair loss is imperative. Further studies are needed to validate the efficacy and safety of these interventions
Advances in Detecting Degenerative and Therapeutic Changes in Intervertebral Discs: Insights from Cyclic Microindentation and Matrix Composition Analysis
No full textObjectives: This study aimed to evaluate degenerative and therapeutic changes in intervertebral discs (IVDs) using cyclic microindentation and matrix composition analysis, focusing on the role of advanced glycation end-products (AGEs) in altering mechanical and biochemical properties.
Patients and methods: Between March 2023 and October 2023 a total of 11 lumbar spines (T12/L1–L5/S1) from donor sample (5 males, 6 females; mean age of 82.5±10.2 years; range, 63 to 99 years) were included in the study. Intervertebral disc degeneration was graded using Thompson criteria and confirmed via fluoroscopy. Cyclic microindentation quantified elastic modulus and tan delta (viscoelastic damping) under in vitro ribosylation to simulate AGE accumulation. Thiazolium salts were applied to assess therapeutic effects. Matrix composition was evaluated for water, proteoglycan, collagen, and AGE content, with statistical analyses correlating mechanical and biochemical changes.
Results: Ribosylation increased AGE levels, significantly reducing viscoelasticity in nucleus pulposus (NP) tissues and stiffness in annulus fibrosus (AF) tissues. Advanced glycation end-products accumulation disrupted proteoglycan functionality and hydration, exacerbating degeneration. Thiazolium salt treatment reduced AGE levels, improving NP viscoelasticity, AF stiffness, and hydration. Correlation analyses demonstrated significant relationships between AGE levels, mechanical properties, and matrix composition.
Conclusion: Cyclic microindentation effectively identified AGE-induced mechanical impairments in IVD tissues. Advanced glycation end-products accumulation plays a critical role in IVD degeneration by altering matrix composition and mechanical behavior. Thiazolium salts reversed these changes, highlighting AGE modulation as a promising therapeutic strategy. Future research should integrate advanced imaging and in vivo studies to optimize AGE-targeted therapies for degenerative disc disease
m6A RNA Methylation in Psychiatric Disorders: An Emerging Epitranscriptomic Axis
No full textN6-methyladenosine (m6A) is the most prevalent internal modification in eukaryotic messenger RNA (mRNA) and plays a vital role in post-transcriptional gene regulation. In recent years, m6A has emerged as a pivotal epitranscriptomic signal involved in neural development, synaptic remodeling, and the molecular pathophysiology of neuropsychiatric disorders. In this review, we summarize the mechanisms underlying the deposition, removal, and recognition of m6A by dedicated methyltransferases, demethylases, and RNA-binding proteins. We further explore how these dynamic modifications influence neuronal differentiation and memory formation. Recent studies have linked aberrant m6A regulation to psychiatric conditions such as depression, anxiety, schizophrenia, and bipolar disorder. Additionally, we discuss how pharmacological or genetic modulation of m6A pathways may promote adaptive neural plasticity and enhance cognitive and emotional resilience. Despite these promising findings, significant challenges remain in achieving spatial and temporal specificity while minimizing off-target effects in the brain. Therefore, we advocate for more in-depth investigations into m6A function within developmentally defined neural circuits to better understand its enduring role in maintaining neural homeostasis
A Narrative Review of Evidence, Safety, and Clinical Considerations in Taxane Chemotherapy for Pregnancy-Associated Breast Cancer
No full textThe medical condition of pregnancy-associated breast cancer (PABC) requires oncologists to determine the best way to protect both the mother and the fetus during cancer treatment. The safety profile of taxanes, including paclitaxel and docetaxel, in the second and third trimesters of pregnancy remains unclear despite well-established anthracycline-based regimens (e.g., doxorubicin). High-risk breast cancer subtypes such as triple negative breast cancer (TNBC) and human epidermal growth factor receptor (HER2)-positive disease require taxane chemotherapy as standard treatment in nonpregnant patients. Objective: This paper aims to gather available data about the safety, timing and fetal outcomes related to taxane chemotherapy during PABC, focusing on pharmacological and clinical guidance. Methods: A targeted literature review of PubMed and Scopus databases was performed to identify case series, cohort studies, and clinical guidelines addressing taxane use during pregnancy. This was not conducted as a formal systematic review or meta-analysis, but as a comprehensive narrative synthesis of available data. Results: The pharmacological properties of paclitaxel and docetaxel limit their placental transfer. Paclitaxel has not been associated with increased congenital anomalies; however, the long-term developmental data remain limited. Similarly, docetaxel administration shows no increase in major malformations. The most common approach used in PABC is to administer anthracyclines first and taxanes after 16–18 weeks’ gestation. The adverse effects experienced by pregnant patients match those experienced by nonpregnant patients. Conclusions: Taxanes can be used with caution after the first trimester in patients with PABC, especially in high-risk cases following anthracycline treatment. The absence of randomized trials combined with limited developmental data highlight the need for more standardized treatment approaches, aligning with current guideline recommendations
Intubating Stylets in the Emergency Department: A Video Review of First-pass Success and Time
No full textIntroduction: Effective airway management is critical for optimal patient outcomes in the emergency department (ED). Additionally, airway management is significantly influenced by the clinician’s selection of equipment, specifically the choice of intubating stylet. Also of note, the duration of intubation (time to intubate) impacts overall success. The choice of intubation device may influence first-pass success and intubation times. In this study we evaluated equipment trends for first-pass success and intubation duration. We collected data by reviewing a video database of recorded airways. Three commonly used intubating stylets were reviewed: the hyperangulated stylet; bougie (Eschmann stylet); and malleable stylet.
Methods: In this retrospective observational study, we reviewed 615 intubation videos. These videos were recorded via video laryngoscopy at the University of Kansas Medical Center and The University of Kansas Health System between February 2019–January 2022. We recorded device type, number of intubation attempts, and time to successful intubation (time from entry of laryngoscope blade to passage of endotracheal tube through vocal cords). We included and analyzed 575 intubations for first-pass success, while a random subset of 70 intubations was used to evaluate intubation times. We also conducted a survey to query current faculty and resident physicians regarding their preference for intubation modality.
Results: Among 575 intubations, the bougie (Eschmann stylet) was used in 47.1% of cases, the malleable stylet in 27.3%, and the hyperangulated (also known as “rigid” or “angular”) stylet in 25.6%. Overall first-pass success was 91.3%. The malleable stylet showed the highest success rate (94.9%), followed by the hyperangulated stylet (93.2%), and the bougie (88.2%) (χ² = 6.53, P = .04). In a separate analysis of 70 cases, the median intubation time was 35.5 seconds. For intubation time, we found a significant difference between the three modalities (χ² = 8.2019, P = .02), with pairwise differences between bougie vs malleable stylet (P = .01) and bougie vs hyperangulated stylet (P = .02), but not between hyperangulated and malleable stylets (P = .62). Bougie-assisted intubations had the highest median time of 40.5 seconds (mean 49.15 +/- 23.1) compared to malleable stylet 31 seconds (mean 33.8 +/- 16.4) and hyperangulated 31 seconds (mean 33.6 +/- 11). A survey of 52 physicians showed that 55.8% preferred the malleable stylet, 19.2% preferred the hyperangulated stylet, and 25% preferred the bougie.
Conclusion: The malleable stylet demonstrated the highest first-pass success rate and the most consistent intubation times, while the bougie had the longest times and lowest success rate in our ED. Physician preferences also favored the malleable stylet. First-pass success rates and intubation times vary depending on an institution’s familiarity with specific devices and the clinician’s preference. These factors should be considered when selecting intubation equipment to optimize airway management outcomes or facilitate training
Candida Glabrata Vertebral Osteomyelitis Following L3-4 Transforaminal Lumbar Fusion: Illustrative Case
No full textBackground: Candida vertebral osteomyelitis is rare, particularly following instrumented spine surgery. Candida glabrata presents additional management challenges due to its frequent resistance to azole antifungal treatment and its association with immunocompromised hosts.
Observations: A 74-year-old immunosuppressed man underwent L3-4 transforaminal lumbar interbody fusion with cyst excision. Seven weeks postoperatively, he presented with constitutional symptoms and elevated inflammatory markers but was discharged with presumed viral illness. Nine months after surgery, imaging revealed cage displacement. Intraoperative cultures during hardware removal identified C. glabrata. The patient underwent repeat irrigation and debridement with hardware exchange and was treated with intravenous micafungin and oral fluconazole and later transitioned to posaconazole. Despite ongoing antifungal therapy, inflammatory markers remained elevated, and follow-up imaging showed progressive vertebral destruction without hardware failure. The patient continues on chronic antifungal suppression with multidisciplinary monitoring.
Lessons: This case highlights the diagnostic and therapeutic challenges of postoperative C. glabrata vertebral osteomyelitis. Early suspicion, culture confirmation, and organism-specific antifungal therapy, alongside timely surgical management, are critical to achieving infection control and preserving spinal stability in immunosuppressed patients