Apixaban Use in Obese Patients: A Review of the Pharmacokinetic, Interventional, and Observational Study Data.

Relatively little is known about the influence of extreme body weight on the pharmacokinetics (PK), pharmacodynamics (PD), efficacy, and safety of drugs used in many disease states. While direct oral anticoagulants (DOACs) have an advantage over warfarin in that they do not require routine drug monitoring, some may regard this convenience as less compelling in obese patients. Some consensus guidelines discourage using DOACs in patients weighing > 120 kg or with a body mass index > 35-40 kg/m, given a sparsity of available data in this population and the concern that fixed dosing in obese patients might lead to decreased drug exposure and lower efficacy.

Follistatin improves skeletal muscle healing after injury and disease through an interaction with muscle regeneration, angiogenesis, and fibrosis.

Recovery from skeletal muscle injury is often incomplete because of the formation of fibrosis and inadequate myofiber regeneration; therefore, injured muscle could benefit significantly from therapies that both stimulate muscle regeneration and inhibit fibrosis. To this end, we focused on blocking myostatin, a member of the transforming growth factor-β superfamily and a negative regulator of muscle regeneration, with the myostatin antagonist follistatin. In vivo, follistatin-overexpressing transgenic mice underwent significantly greater myofiber regeneration and had less fibrosis formation compared with wild-type mice after skeletal muscle injury.

Technical tricks when using the reamer irrigator aspirator technique for autologous bone graft harvesting.

This report describes technical tricks for using the reamer irrigator aspirator to harvest autologous bone graft from the femur. This device is a focus of interest in orthopaedics because it can be used to harvest bone graft from the femoral canal and medial condyle in voluminous quantities. Moreover, according to some authors, the osteogenic potential of this graft is at least as effective as that of autogenous bone obtained from the iliac crest.

The personal interview: assessing the potential for personality similarity to bias the selection of orthopaedic residents.

Purpose: The selection of medical students for training in orthopaedic surgery consists of an objective screening of cognitive skills to secure interviews for the brightest candidates, followed by subjective measures of candidates to confirm whether applicants are worthy of further consideration. The personal interview and its potential biased impact on the orthopaedic workforce were evaluated.

Method: During 2004-2006 at the Penn State College of Medicine, the authors performed a prospective cohort study in which 30 consenting interviewers and 135 interviewees completed the Myers-Briggs Type Indicator before the interviews.

Stem cells for the treatment of skeletal muscle injury.

Skeletal muscle injuries are extremely common, accounting for up to 35%-55% of all sports injuries and quite possibly affecting all musculoskeletal traumas. These injuries result in the formation of fibrosis, which may lead to the development of painful contractures, increases patients' risk for repeat injuries, and limits their ability to return to a baseline or pre-injury level of function. The development of successful therapies for these injuries must consider the pathophysiology of these musculoskeletal conditions.

Case report: The prone reduction of a sacroiliac disruption with a pelvic C-clamp.

The pelvic C-clamp traditionally is reserved for the temporizing stabilization of posterior ring injuries and reportedly has assisted in closed reduction of sacroiliac diastases, for patients who are in the supine position. We report a patient with a severely displaced Zone II sacral fracture and associated acetabular fracture who initially underwent fixation of the acetabulum in the prone position. By using the pelvic C-clamp as a tool for successfully reducing the sacrum, definitive closed fixation of the pelvic wing subsequently was performed without having to reposition the patient.

Dominant negative Bmp5 mutation reveals key role of BMPs in skeletal response to mechanical stimulation.

Background: Over a hundred years ago, Wolff originally observed that bone growth and remodeling are exquisitely sensitive to mechanical forces acting on the skeleton. Clinical studies have noted that the size and the strength of bone increase with weight bearing and muscular activity and decrease with bed rest and disuse. Although the processes of mechanotransduction and functional response of bone to mechanical strain have been extensively studied, the molecular signaling mechanisms that mediate the response of bone cells to mechanical stimulation remain unclear.