Targeting the Gut Microbiome for Inflammation and Pain Management in Orthopedic Conditions.

The human gut microbiome can be altered with probiotics, prebiotics, synbiotics, and anti-inflammatory foods and spices as part of an evidence-based strategy that targets inflammation and pain in common orthopedic conditions. Implementing these strategies avoids adverse effects associated with nonsteroidal anti-inflammatory drugs and minimizes the potential for opioid use. This review focuses exclusively on human trials studying the effects of gut microbiome alterations to address pain and inflammatory markers in common orthopedic conditions: osteoarthritis, rheumatoid arthritis, fractures/osteoporosis, and bone pain associated with chemotherapy.

A Soft Robotic Sleeve for Compression Therapy of the Lower Limb.

'We present the development of a soft robotic-inspired device for lower limb compression therapy with application in the treatment of lymphedema. This device integrates the control capabilities of pneumatic devices with the wearability and low cost of compression garments. The design consists of a three-layered soft robotic sleeve that ensures safe skin contact, controls compression, and secures the device to the patient limb.

Hoverboard injuries in children and adolescents: results of a multicenter study.

With the increasing popularity of hoverboards in recent years, multiple centers have noted associated orthopaedic injuries of riders. We report the results of a multi-center study regarding hoverboard injuries in children and adolescents. who presented with extremity fractures while riding hoverboards to 12 paediatric orthopaedic centers during a 2-month period were included in the study.

Characterizing the recovery trajectories of knee range of motion for one year after total knee replacement.

: Retrospective analysis of routinely collected clinical data. : This study modeled the recovery in knee flexion and extension range of motion (ROM) over 1 year after total knee replacement (TKR). : Recovery after TKR has been characterized for self-reported pain and functional status.

Novel 3D Hybrid Nanofiber Aerogels Coupled with BMP-2 Peptides for Cranial Bone Regeneration.

An ideal synthetic bone graft is a combination of the porous and nanofibrous structure presented by natural bone tissue as well as osteoinductive biochemical factors such as bone morphogenetic protein 2 (BMP-2). In this work, ultralight 3D hybrid nanofiber aerogels composed of electrospun PLGA-collagen-gelatin and Sr-Cu codoped bioactive glass fibers with incorporation of heptaglutamate E7 domain specific BMP-2 peptides have been developed and evaluated for their potential in cranial bone defect healing. The nanofiber aerogels are surgically implanted into 8 mm × 1 mm (diameter × thickness) critical-sized defects created in rat calvariae.

Nanofiber-based sutures induce endogenous antimicrobial peptide.

Aim: The aim of this study was to develop nanofiber-based sutures capable of inducing endogenous antimicrobial peptide production.

Methods: We used co-axial electrospinning deposition and rolling to fabricate sutures containing pam3CSK4 peptide and 25-hydroxyvitamin D (25D).

Results: The diameters and mechanical properties of the sutures were adjustable to meet the criteria of United States Pharmacopeia designation.

Binary Doping of Strontium and Copper Enhancing Osteogenesis and Angiogenesis of Bioactive Glass Nanofibers while Suppressing Osteoclast Activity.

Electrospun bioactive glass fibers show great potential as scaffolds for bone tissue engineering due to their architectural biomimicry of the bone extracellular matrix and their composition capable of providing soluble bioactive cues for bone regeneration and remodeling. Trace elements can be doped to further promote osteogenesis and angiogenesis during bone regeneration. Cationic substitution of strontium for calcium in bioactive glass positively enhances osteoblast phenotype, while suppressing osteoclast activity.

Twisting electrospun nanofiber fine strips into functional sutures for sustained co-delivery of gentamicin and silver.

Surgical site infections (SSIs) represent the most common nosocomial infection among surgical patients. In order to prevent SSIs in a sustained manner and lessen side effects, we developed a twisting method for generation of nanofiber-based sutures capable of simultaneous delivery of silver and gentamicin. The prepared sutures are composed of core-sheath nanofibers with gentamicin/pluronic F127 in the core and silver/PCL in the sheath produced by co-axial electrospinning.

An Anatomical Study on the Safe Placement of Orthopedic Hardware for Syndesmosis Fixation.

Articular cartilage and bony contact at the distal tibiofibular cartilage contact zone (TFCCZ) is variable. The appropriate placement of syndesmotic hardware would benefit from a more accurate characterization of the proximal extent of the TFCCZ allowing surgeons to place hardware that simultaneously improves biomechanical stability and decreases the risk of iatrogenic cartilage damage. In addition, Ilizarov wire fixation through the distal fibula and tibia can pass through the syndesmosis recess.

Hip Pain in the Pre-Arthritic Patient: A Guide for the Primary Care Physician.

Adolescents and young adults (less than 30 years of age) with pre-arthritic hip pain constitute a diagnostic dilemma for the primary care physician. The most common underlying diagnoses range from benign muscle strains/joint sprains to stress reactions, insufficiency fractures, and tears involving the articular cartilage/labrum in the setting of femoroacetabular impingement, a hip shape abnormality that is present in up to 90% of this age group. Undetected or left untreated these seemingly innocuous disorders can result in significant loss of function and, in some cases, irreversible joint damage.

Improving Rural Bone Health and Minimizing Fracture Risk in West Virginia: Validation of the World Health Organization FRAX Assessment Tool as a Phone Survey for Osteoporosis Detection.

West Virginia ranks second nationally in population ≥ 65 years old placing our state at greater risk for osteoporosis and fracture. The gold standard for detecting osteoporosis is dual X-ray absorptiometry (DXA), yet over half of West Virginia's counties do not have this machine. Due to access barriers, a validated phone-administered fracture prediction tool would be beneficial for osteoporosis screening.

Patient-Controlled Fentanyl Iontophoretic Transdermal System Improved Postoperative Mobility Compared to Intravenous Patient-Controlled Analgesia Morphine: A Pooled Analysis of Randomized, Controlled Trials.

Background: Postoperative pain management protocols that use patient-controlled analgesia (PCA) can hinder mobility due to attached machinery and tubing. Immobility in the postoperative setting can increase complications, length of stay (LOS), and costs. Early and enhanced mobilization can reduce the cost of care while improving patient outcomes.

Highly controlled coating of strontium-doped hydroxyapatite on electrospun poly(ɛ-caprolactone) fibers.

Electrospun fibers show great potential as scaffolds for bone tissue engineering due to their architectural biomimicry to the extracellular matrix (ECM). Cation substitution of strontium for calcium in hydroxyapatite (HAp) positively influences the mechanism of bone remodeling including enhancing bone regeneration and reducing bone resorption. The objective of this study was to attach strontium-doped HAp (SrHAp) to electrospun poly(ɛ-caprolactone) (PCL) fibers for creation of novel composite scaffolds that can not only mimic the architecture and composition of ECM but also affect bone remodeling favorably.

Primary Care Management of Plantar Fasciitis.

Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus.

Primary Care Fall Risk Assessment for Elderly West Virginians.

West Virginia is ranked second nationally for the percent of its population 65 years of age. The elderly are especially susceptible to falls with fall risk increasing as age increases. Because falls are the number one cause of injury-related morbidity and mortality in the West Virginia elderly, evaluation of fall risk is a critical component of the patient evaluation in the primary care setting.

Smartphone Mobile Applications to Enhance Diagnosis of Skin Cancer: A Guide for the Rural Practitioner.

Primary care physicians occupy a vital position to impact many devastating conditions, especially those dependent upon early diagnosis, such as skin cancer. Skin cancer is the most common cancer in the United States and despite improvements in skin cancer therapy, patients with a delay in diagnosis and advanced disease continue to have a grave prognosis. Due to a variety of barriers, advanced stages of skin cancer are more prominent in rural populations.

Delayed Pseudoaneurysm of the Popliteal Artery Following ACL Reconstruction.

Arterial complications following arthroscopic anterior cruciate ligament (ACL) reconstruction of the knee are rare. Injuries to vascular structures around the knee have historically been reported more commonly, with reconstructive procedures occurring more posteriorly, such as posterior cruciate ligament (PCL) reconstruction. The authors present a report of sequelae following a postoperative popliteal artery spasm in an 18-year-old female soccer player who underwent ACL reconstruction using an ipsilateral autologous hamstring graft along with a medial meniscal repair and developed immediate spasm of the popliteal artery responding to sustained balloon angioplasty.

Electrospun nanofiber scaffolds with gradations in fiber organization.

The goal of this protocol is to report a simple method for generating nanofiber scaffolds with gradations in fiber organization and test their possible applications in controlling cell morphology/orientation. Nanofiber organization is controlled with a new fabrication apparatus that enables the gradual decrease of fiber organization in a scaffold. Changing the alignment of fibers is achieved through decreasing deposition time of random electrospun fibers on a uniaxially aligned fiber mat.

Local Sustained Delivery of 25-Hydroxyvitamin D3 for Production of Antimicrobial Peptides.

Purpose: This study seeks to develop fiber membranes for local sustained delivery of 25-hydroxyvitamin D3 to induce the expression and secretion of LL-37 at or near the surgical site, which provides a novel therapeutic approach to minimize the risk of infections.

Methods: 25-hydroxyvitamin D3 loaded poly(L-lactide) (PLA) and poly(ε-caprolactone) (PCL) fibers were produced by electrospinning. The morphology of obtained fibers was characterized using atomic force microscope (AFM) and scanning electron microscope (SEM).

Too smart to fail: guide for the struggling medical student.

Medicine is a vocation of perpetual independent learning; long-term success is critically dependent on finding the right resources and establishing effective study methods and test-taking strategies. Students who struggle with the academic transition in medical school have common risk factors and characteristics. We highlight key resources that are available for struggling medical students with an emphasis on West Virginia's HELP, ASPIRE, and STAT programs.

Unilateral heat accelerates bone elongation and lengthens extremities of growing mice.

Linear growth failure results from a broad spectrum of systemic and local disorders that can generate chronic musculoskeletal disability. Current bone lengthening protocols involve invasive surgeries or drug regimens, which are only partially effective. Exposure to warm ambient temperature during growth increases limb length, suggesting that targeted heat could noninvasively enhance bone elongation.

Preventing falls with vitamin D.

Falls are the number one cause for injury-related morbidity and mortality in West Virginia's seniors. Multiple independent variables contribute to the risk of a fall: previous falls, alterations in balance and vision, impairments in gait and strength, and medications most highly correlate with the risk for a fall. Vitamin D supplementation is emerging as an easy, safe and well-tolerated fall reduction/prevention strategy due to the beneficial effects on the musculoskeletal system with improvements in strength, function and navigational abilities.

Smartphone medical applications useful for the rural practitioner.

Like other similarly situated rural states, West Virginia's patients and practitioners often experience access barriers to current medical expertise for multiple disciplines. This article was generated to help bridge this gap and highlights the best-rated mobile medical applications (Apps) for smartphone use. From finding drug interactions and dosing schedules to discussing patients in HIPAA-compliant formats, Apps are becoming integral to the practice of 21st Century medicine.