Orthopedic Training in the United States A Continuously Evolving Process.

Orthopedic surgery in the United States has gone through many changes over the past few centuries. Starting with a small sect of subspecialized surgeons, advances in technology and surgical skills have paralleled the growth of the specialty. To keep up with demand, the training of orthopedic surgeons has undergone many iterations.

Open in Case of SOAP Emergency: Preparation for and Recovery after Failing to Match.

Failing to secure an internship is an extremely stressful event. In this manuscript we describe a process to prepare students for success, should they fail to match. This process involves an assessment of individual vulnerability, implementing mitigation strategies, developing a comprehensive plan in the event of failing to match, that is executed if the student needs to enter the Supplemental Offer Acceptance Program (SOAP) or the "scramble".

Cerebrospinal fluid immunoglobulins in primary progressive multiple sclerosis are pathogenic.

Multiple sclerosis is clinically characterized by relapses and remissions (relapsing-remitting multiple sclerosis) that over time may evolve to a progressive course (secondary progressive multiple sclerosis) or as having a progressive course from disease onset (primary progressive multiple sclerosis). At present, it is not definitively known whether these clinical entities constitute a single pathological disease or whether these manifestations represent two distinct disease entities sharing inflammatory demyelination as a pathological feature. Here we show using a novel mouse model that CSF of primary progressive multiple sclerosis patients is unique in its capacity to induce motor disability and spinal cord pathology including demyelination, impaired remyelination, reactive astrogliosis and axonal damage.

Apolipoprotein B-100-mediated motor neuron degeneration in sporadic amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis is a fatal neurodegenerative disease characterized by motor neuron degeneration. Approximately 90% of cases occur sporadically with no known cause while 10% are familial cases arising from known inherited genetic mutations. studies have predominantly utilized transgenic models harbouring amyotrophic lateral sclerosis-associated gene mutations, which have not hitherto elucidated mechanisms underlying motor neuron death or identified therapeutic targets specific to sporadic amyotrophic lateral sclerosis.

Empowering the Resident Learner.

Surgical resident autonomy is an essential element of the transition from supervised training to independent practice. However, in an age of duty hour restrictions, legislative constraints, increased litigation, and heightened societal expectations, training an autonomous resident proves increasingly difficult. To tackle these barriers to training successful surgeons, the American College of Surgeons Committee on Resident Education initiated the Resident Mentored Autonomy Project.

CD8 T Cells Expressing an HLA-DR1 Chimeric Antigen Receptor Target Autoimmune CD4 T Cells in an Antigen-Specific Manner and Inhibit the Development of Autoimmune Arthritis.

Ag-specific immunotherapy is a long-term goal for the treatment of autoimmune diseases; however developing a means of therapeutically targeting autoimmune T cells in an Ag-specific manner has been difficult. Through the engineering of an HLA-DR1 chimeric Ag receptor (CAR), we have produced CD8 CAR T cells that target CD4 T cells in an Ag-specific manner and tested their ability to inhibit the development of autoimmune arthritis in a mouse model. The DR1 CAR molecule was engineered to contain CD3ζ activation and CD28 signaling domains and a covalently linked autoantigenic peptide from type II collagen (CII; DR1-CII) to provide specificity for targeting the autoimmune T cells.

Virtual interviews - Utilizing technological affordances as a predictor of applicant confidence.

Purpose: In the midst of a pandemic, residency interviews transitioned to a virtual format for the first time. Little is known about the effect this will have on the match process. The study aim is to evaluate resident application processes and perceived outcomes.

Surveillance Colonoscopy Revealing Asymptomatic Low-Grade Appendiceal Mucinous Neoplasm.

Appendicular mucinous neoplasms are a collection of rare tumors with diverse clinical presentations and pathologic potential, which can cause diagnostic and therapeutic challenges. Traditionally, they are diagnosed by radiologic imaging or identified intraoperatively; however, rarely, they may be diagnosed during an endoscopic procedure. In this unusual case, we present the case of a 62-year-old Caucasian male undergoing routine surveillance colonoscopy due to a history of colonic neoplasia.

Medical Student Selection.

Medical school admissions committees are tasked with fulfilling the values of their institutions through careful recruitment. Making accurate predictions regarding the enrollment behavior of admitted students is critical to intentionally formulating class composition and impacts long-term physician representation.

A Rare Case of Spontaneous Idiopathic Pneumoperitoneum Presenting as Abdominal Pain.

Idiopathic spontaneous pneumoperitoneum is caused by free air in the peritoneum when no established cause has been diagnosed. We present the case of a 61-year-old male with idiopathic spontaneous pneumoperitoneum, which started as abrupt abdominal pain. He described burning abdominal pain radiating to his right shoulder and endorsed symptoms of nausea, abdominal bloating, and heartburn but denied fever, chills, or vomiting.

Promoting Access of Osteopathic Medical Students to Surgical Residency Training Programs.

The COVID-19 pandemic has uncovered disparities for allopathic and osteopathic surgical applicants for the upcoming 2021 residency application cycle. It has provided an opportunity for change to the current paradigm in surgical resident selection. This study seeks to quantify the disproportionality of opportunities between allopathic and osteopathic students and provides solutions to level the playing field for all applicants.

Intraobserver and Interobserver Reliability of the Peritubercle Lucency Sign in Slipped Capital Femoral Epiphysis.

Background: An area of enlargement of the metaphyseal socket around the epiphyseal tubercle, termed the peritubercle lucency sign, has recently been introduced as a possible predictor of contralateral slipped capital femoral epiphysis in patients with previous unilateral slipped capital femoral epiphysis. This study aimed to assess intraobserver and interobserver reliability for detecting the presence or absence of the peritubercle lucency sign.

Methods: Thirty-five radiographs were presented to 6 fellowship-trained pediatric orthopaedic surgeons on 2 separate occasions 30 days apart, ensuring that the images were shown in a different order on the second exposure.

Kinetic versus thermodynamic metalation enables synthesis of isostructural homo- and heterometallic trinuclear clusters.

Temperature-dependent metalation of the new hexadentate ligand (tris(5-(pyridin-2-yl)-1H-pyrrol-2-yl)methane; HTPM) enables the selective synthesis of both mononuclear (i.e. Na(THF)[Fe(TPM)], kinetic product) and trinuclear (i.

Surveillance Intensity Comparison by Risk for T1NX Locally Excised Rectal Adenocarcinoma: a Cost-Effective Analysis.

Background: Controversy exists regarding the optimal surveillance strategy following local excision of T1NX rectal adenocarcinoma. This study aims to determine the cost-effectiveness of surveillance strategies for locally excised T1NX rectal adenocarcinoma based on histopathologic and local staging risk factors.

Methods: A Markov model with 10-year follow-up was developed for cost-effectiveness analysis of high-, medium-, and low-intensity surveillance strategies after local excision of T1NX rectal adenocarcinoma.

Flexible intramedullary nailing of femoral shaft fractures: closed versus open reduction.

Children's femoral shaft fractures are commonly treated with flexible intramedullary nailing after closed or open reduction, but there is little information concerning indications for open reduction. The purpose of this study was to determine radiographic and clinical features likely to lead to open reduction before flexible intramedullary nailing. Record review identified 158 femoral shaft fractures treated with flexible intramedullary nailing.

Cost-Effectiveness Analysis of Total Neoadjuvant Therapy Followed by Radical Resection Versus Conventional Therapy for Locally Advanced Rectal Cancer.

Background: Definitive surgery with total mesorectal excision is the mainstay of treatment for locally advanced rectal cancer. Multimodality therapy improves long-term survival. Current standards advise neoadjuvant chemoradiation followed by radical surgery and adjuvant chemotherapy.

Strength and Stability Analysis of Rehabilitated Anterior Cruciate Ligament Individuals.

The anterior cruciate ligament (ACL) serves as a vital stabilizer for the human knee, yet it is one of the most injured ligaments in the body. Function of the knee is restored through reconstruction and physical therapy, but long term functional deficits persist in some individuals. To better understand the influence of post rehabilitation outcomes on dynamic balance performance, this study evaluated bilateral differences in strength and stability in 11 participants who have rehabilitated from an ACL reconstruction or repair.

What happens after a failed LIFT for anal fistula?

Background: Ligation of the intersphincteric fistula tract (LIFT) was developed to treat transsphincteric anal fistulas. The aftermath of a failed LIFT has not been well documented.

Methods: Retrospective chart review of LIFT procedure for transsphincteric anal fistula between March 2012 and September 2016.

Factors that predict instability in pediatric diaphyseal both-bone forearm fractures.

The aim of this study was to determine the factors that may predict failure of closed reduction and casting of diaphyseal forearm fractures in children. Demographic and radiographic data of children with closed reduction and casting of these fractures in the emergency department were evaluated. Of 174 patients with adequate follow-up to union, 19 (11%) required a repeat procedure.

Molecular Markers for Colorectal Cancer.

Colorectal cancers develop through at least 3 major pathways, including chromosomal instability, mismatch repair, and methylator phenotype. These pathways can coexist in a single individual and occur in both sporadic and inherited colorectal cancers. In spite of the unique molecular and genetic signatures of colorectal cancers, nonspecific chemotherapy based on the antineoplastic effects of 5-fluorouracil is the cornerstone of therapy for stage III and some stage II disease.

Caregiving setting and Baby Boomer caregiver stress processes: Findings from the National Study of Caregiving (NSOC).

The aim of this study was to provide a comprehensive understanding of how the caregiving setting relates to caregiving experience among Baby Boomer caregivers (CGs). Based on a secondary data analysis (the National Study of Caregiving, N = 782), compared with CGs providing care to an older adult living in the community, CGs to older adults in non-NH residential care settings reported better emotional well-being, self-rated health, and relationship quality and less provision of assistance older adults with daily activities. While chronic conditions, relationship quality, and financial strain were associated with the health and well-being for both CG groups, degree of informal support was more consequential for the health of CGs providing care to older adults in the community.

Flight simulation using a Brain-Computer Interface: A pilot, pilot study.

As Brain-Computer Interface (BCI) systems advance for uses such as robotic arm control it is postulated that the control paradigms could apply to other scenarios, such as control of video games, wheelchair movement or even flight. The purpose of this pilot study was to determine whether our BCI system, which involves decoding the signals of two 96-microelectrode arrays implanted into the motor cortex of a subject, could also be used to control an aircraft in a flight simulator environment. The study involved six sessions in which various parameters were modified in order to achieve the best flight control, including plane type, view, control paradigm, gains, and limits.