POPULARITY
20 episodes with allograft
6 episodes with allograft
6 episodes with allograft
6 episodes with allograft
2 episodes with allograft
2 episodes with allograft
3 episodes with allograft
2 episodes with allograft
2 episodes with allograft
In this episode, Ayesha and Andrew discuss the September 2, 2026 issue of JBJS, along with an added dose of entertainment and pop culture. Listen at the gym, on your commute, or whenever your case is on hold! Link: JBJS website: https://jbjs.org/issue.php Sponsor: This episode is brought to you by JBJS Clinical Classroom. Subspecialties: Orthopaedic Essentials, Shoulder, Oncology, Spine, Rehabilitation, Basic Science, Knee, Ethics Chapters (00:00:02) - Your Cases On Hold(00:03:12) - The New in Orthopedic Rehabilitation: Orthobiologics(00:05:32) - VEGF Inhibitor reinitiation and wound complications in(00:14:13) - VEGF Inhibitors and wound complications(00:22:59) - Reversible Shoulder Arthroplasty with an Allograft(00:27:19) - Post-operative complications of iliac crest bone grafting(00:29:08) - The Essential Surgical Techniques article(00:33:54) - Case On Hold(00:34:21) - Prevascularized Bone marrow Stem Cell Sheets Promote T(00:44:07) - Oh, Well...
Today's episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox. So, without further ado, let's get to the Field House!
Live from the Arthrex Team Physician Controversies ConferenceIn this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leading ACL experts—Dr. Pat Smith and Dr. Aaron Krych—to discuss strategies to reduce failure after ACL reconstruction.The conversation highlights the evolution of ACL surgery, focusing on graft selection, fixation, biologic augmentation, and mechanical protection, with an emphasis on optimizing outcomes in young, high-risk athletes.Graft: Autograft vs AllograftStrong evidence shows higher failure rates with allograft in young athletes MOON data: ~4–6x increased risk of failure in patients
Jaypirca gains expanded approval; allograft approved to restore peripheral nerve function; baxdrostat to be reviewed as an add-on treatment for hypertension; treatment for a genetic eye disorder that causes vision loss shows promise; and an autoinjector to treat edema is accepted for Priority Review.
Return to Sport After Meniscal Allograft Transplantation in Collegiate and Professional Athletes Sachs JP, Mufti YN, Rubin J, et al. Am J Sports Med. 2025 Sep 3. doi:10.1177/03635465251366445 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest VALD MoveHealth - https://movehealth.me/ Learn more about/Buy Erik/Jason/Chris's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux
Welcome to the Sterile Technique Podcast! It's the podcast about Surgical Technology. Whether you are a CST or CSFA, this podcast helps you earn CE credits and improve your surgery skills in the OR. This episode discusses an article in the August 2025 issue of The Surgical Technologist, the official journal of the Association of Surgical Technologists (AST). The article is titled, "The Ross Procedure: Cardiac Autograft and Allograft, Part 2". "Scrub in" at steriletpodcast.com and on Twitter, @SterileTPodcast (twitter.com/SterileTPodcast). This podcast is a Dybas Media production. Sound effects adapted from GarageBand and sindhu.tms at https://freesound.org/people/sindhu.tms/sounds/169065/ and licensed courtesy of https://creativecommons.org/licenses/by-nc/3.0/.
Welcome to the Sterile Technique Podcast! It's the podcast about Surgical Technology. Whether you are a CST or CSFA, this podcast helps you earn CE credits and improve your surgery skills in the OR. This episode discusses an article in the July 2025 issue of The Surgical Technologist, the official journal of the Association of Surgical Technologists (AST). The article is titled, "The Ross Procedure: Cardiac Autograft and Allograft, Part 1". "Scrub in" at steriletpodcast.com and on Twitter, @SterileTPodcast (twitter.com/SterileTPodcast). This podcast is a Dybas Media production. Sound effects adapted from GarageBand and sindhu.tms at https://freesound.org/people/sindhu.tms/sounds/169065/ and licensed courtesy of https://creativecommons.org/licenses/by-nc/3.0/.
Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a moon prospective longitudinal cohort Kaeding CC, Aros B, Pedroza A, et al. Sports Health. 2011;3(1):73-81. doi:10.1177/1941738110386185 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik/Jason/Chris's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. Eric Wagner and is titled "Revising the Failed Humerus The Case for Allograft Prosthetic Composites."Follow Orthobullets on Social Media:FacebookInstagram TwitterLinkedIn
Chapters 00:00 Introduction to Tendons and Personal Background 03:01 Understanding ACL Injuries and Rehabilitation 05:56 Graft Types: Autograft vs Allograft 08:56 Early Rehabilitation Strategies for ACL Surgery 11:53 Managing Swelling and Pain Post-Surgery 14:58 Progressing Rehabilitation: From Extension to Strength 17:59 Considerations for Graft Selection 21:01 Challenges with Quad Tendon Grafts 23:52 Hamstring and Patellar Grafts: Pros and Cons 32:06 Understanding Anterior Knee Pain and Rehabilitation 34:40 Strength Training in ACL Recovery 37:49 Introducing Plyometrics in Rehabilitation 39:28 Progressing Plyometrics and Deceleration Training 44:06 The Role of Physical Therapists in ACL Rehab 47:30 Knee Strategy vs. Hip Strategy in Rehabilitation 52:07 Re-injury Rates and Return to Sport Statistics 53:40 Education Gaps in Physical Therapy Schools 57:43 Improving ACL Rehabilitation Practices 01:01:17 Collaboration Between Therapists and Strength Coaches Takeaways Derek Garza is a licensed physical therapist with a background in athletics. He emphasizes the importance of education in ACL rehabilitation. The type of graft used in ACL surgery significantly affects recovery. Early intervention in rehabilitation can lead to better outcomes. Managing swelling is crucial for effective recovery post-surgery. Different graft types have unique healing timelines and considerations. Patient education is key to understanding the rehabilitation process. The strength of the graft can vary significantly based on the type used. Rehabilitation strategies should be tailored to the individual athlete. Understanding the risks and timelines of recovery can help prevent re-injury. The quality of physical therapy coaching is crucial for recovery. Limb symmetry index should be at least 90% for strength. Plyometrics should be introduced gradually in rehabilitation. Deceleration training is essential for athletes returning to sport. Many physical therapists lack knowledge in plyometric training. Re-injury rates for ACL injuries are alarmingly high. Education on plyometrics is lacking in physical therapy schools. Collaboration between therapists and strength coaches is vital. Athletes often shy away from loading their knees post-injury. Understanding knee and hip strategies can improve rehabilitation outcomes. Derek on Instagram: https://www.instagram.com/dr.derekpt/ Derek's Linktree: https://linktr.ee/drderekgarza?fbclid=PAZXh0bgNhZW0CMTEAAafGwPFbijuM4jTC0YjCcgMH2cY3-masDnDR00SYM7QCAyHfVaMUxWiB4ij1GQ_aem_Yj9twOyX7Rp7Un4fBhKFGg Notes: https://jackedathlete.com/podcast-148-acls-and-quad-patellar-hamstring-tendon-grafts-with-derek-garza/
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
In this 306th episode I welcome Dr. Beth Wilson to the show to discuss Early Allograft Dysfunction (EAD) after liver transplantation and what anesthesiologists can do to prevent or mitigate it. Our Sponsors:* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Factor: https://factormeals.com/accrac50off* Check out Thrive Market: https://thrivemarket.com/ACCRAC* Check out Truelearn and use my code ACCRAC for a great deal: https://truelearn.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy
Contributor: Travis Barlock, MD Educational Pearls: Key clinical considerations when managing heart transplant patients due to their unique pathophysiology 1. Arrhythmias A transplanted heart is denervated, meaning it lacks autonomic nervous system innervation The lack of vagal tone results in an increased resting heart rate Adenosine can be used since it primarily slows conduction through the AV node Atropine is ineffective in treating transplant bradyarrhythmia because its mechanism is to inhibit the vagus nerve - but the heart lacks vagal tone Allograft rejection can also cause tachycardia Consult transplant surgery - treatment is usually 500 mg methylprednisolone 2. Rejection Transplant patients are administered immunosuppressants Clinical presentation of acute rejection looks similar to heart failure with increased BNP, increased troponin, and pulmonary edema Cardiac allograft vasculopathy is a form of chronic rejection Patients will not report chest pain due to denervated heart Symptoms are usually weakness and fatigue 3. High risk of infection due to immunosuppression Increased risk of infections which includes CMV, legionella, tuberculosis, etc Immunosuppressants have side effects such as acute kidney injury or pancytopenia 4. Radiographic Cardiomegaly A study found that radiographic cardiomegaly does not connote heart failure They hypothesized it is instead the result of a mismatch between the size of the transplanted heart and the space in the thoracic cavity References Murphy JD, Mergo PJ, Taylor HM, Fields R, Mills RM Jr. Significance of radiographic cardiomegaly in orthotopic heart transplant recipients. AJR Am J Roentgenol. 1998 Aug;171(2):371-4. doi: 10.2214/ajr.171.2.9694454. PMID: 9694454. Park MH, Starling RC, Ratliff NB, McCarthy PM, Smedira NS, Pelegrin D, Young JB. Oral steroid pulse without taper for the treatment of asymptomatic moderate cardiac allograft rejection. J Heart Lung Transplant. 1999 Dec;18(12):1224-7. doi: 10.1016/s1053-2498(99)00098-4. PMID: 10612382. Pethig K, Heublein B, Wahlers T, Dannenberg O, Oppelt P, Haverich A. Mycophenolate mofetil for secondary prevention of cardiac allograft vasculopathy: influence on inflammation and progression of intimal hyperplasia. J Heart Lung Transplant. 2004 Jan;23(1):61-6. doi: 10.1016/s1053-2498(03)00097-4. PMID: 14734128. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/
Our next AAOS 2025 Annual Meeting poster is titled Mid-term Follow-up of Patellofemoral Osteochondral Allograft Transplantation. This study was performed by Dr. Bill Bugbee and his team at the Scripps Clinic. Dr. Bugbee was a guest on our show back in November 2023. That is episode 59 and 60, if you want to go check it out. In that episode, we discussed osteochondral allograft transplantation for various cartilage defects of the knee, including medial and lateral tibiofemoral, which are the more common locations for OCA transplantation. This study focuses specifically on outcomes of OCA transplantation for patellofemoral cartilage defects.This study identified 127 patients undergoing OCA transplantation in the patellofemoral compartment – 51 to the patella, 47 to the trochlea and 29 bipolar patella and trochlea. The most common indication was a degenerative cartilage lesion at 47%, followed by a traumatic cartilage injury at 25% and osteochondritis dissecans at 15%. All patients had a minimum follow-up of 2 years. OCA failure was defined as any reoperation that involved removal of the allograft. Patient reported outcomes were also assessed pre-op and post-op, including the IKDC score and KOOS score.So, what did this study find? First, reoperations occurred in 39% of the knees. Rate of reoperation was not statistically significant between patella, trochlea and bipolar grafts. Second, OCA failures occurred in 16% of the knees at a median 4.4 years following the index surgery, and the most common revision procedure was arthroplasty. Although it did not reach statistical significance, trochlear grafts had a lower failure rate of 9% compared to patellar grafts at 20% and bipolar grafts at 21%.Overall, graft survivorship at 5 and 10 years was 91% and 82%, respectively. Patients with patellar, trochlear and bipolar grafts all had significant improvement in IKDC scores and KOOS scores from preop to the latest follow-up and no statistically significant differences were observed between the groups. Overall, 77% of patients reported being satisfied with the results of the OCA transplantation with no statistically significant differences in satisfaction between the groups.Also check out:Episode 91: Dr. Tom DeBerardino 0n Advances in Patellofemoral Cartilage Restoration
Olivier Visa, President and CEO of Evergen specializes in developing and manufacturing biomaterials for use in regenerative medicine. These customized biomaterial solutions use xenografts, allografts, and emerging technologies inside and outside the body with applications in wound healing, cardiac, dental, breast, neuro, and spine repair. This approach provides surgeons with a broader range of biomaterials to better tailor treatments for individual patients. Olivier explains, "There is a multitude that we can support. There is form and function, and I can give you a couple of examples of biomaterials in regenerative medicine. One is bovine pericardium, which is bovine collagen that we use for the development and manufacturing of cardiac heart valves. Another one would be acellular dermal matrix from human tissue that we use for reconstruction in plastic and, of course, with surgeries such as breast reconstruction after mastectomy." "Think about the body as a whole, and I'll give you a couple of examples where- when you're in cardiac - whether it's a patch or a valve, we're inside the body. When we're in breast reconstruction, we are totally inside the body. When we're in the neuro spine, we're totally inside the body, whether you're repairing or restoring or regenerating peripheral nerves or dura around the brain, you're inside the body. And yes, you are right, wound management is part of it, whether it's diabetic food, ulcer, ulcer or some form of a burn, then I would say you're looking at the skin as an organ and repairing, restoring, and regenerating that skin." #Evergen #TissueEngineering #RegenerativeMedicine #CDMO #Biomaterials #Biotechnology #LifeSciences #MedicalDevices #SportsMedicine #Orthopedics #Surgeons evergenbio.com Download the transcript here
Olivier Visa, President and CEO of Evergen specializes in developing and manufacturing biomaterials for use in regenerative medicine. These customized biomaterial solutions use xenografts, allografts, and emerging technologies inside and outside the body with applications in wound healing, cardiac, dental, breast, neuro, and spine repair. This approach provides surgeons with a broader range of biomaterials to better tailor treatments for individual patients. Olivier explains, "There is a multitude that we can support. There is form and function, and I can give you a couple of examples of biomaterials in regenerative medicine. One is bovine pericardium, which is bovine collagen that we use for the development and manufacturing of cardiac heart valves. Another one would be acellular dermal matrix from human tissue that we use for reconstruction in plastic and, of course, with surgeries such as breast reconstruction after mastectomy." "Think about the body as a whole, and I'll give you a couple of examples where- when you're in cardiac - whether it's a patch or a valve, we're inside the body. When we're in breast reconstruction, we are totally inside the body. When we're in the neuro spine, we're totally inside the body, whether you're repairing or restoring or regenerating peripheral nerves or dura around the brain, you're inside the body. And yes, you are right, wound management is part of it, whether it's diabetic food, ulcer, ulcer or some form of a burn, then I would say you're looking at the skin as an organ and repairing, restoring, and regenerating that skin." #Evergen #TissueEngineering #RegenerativeMedicine #CDMO #Biomaterials #Biotechnology #LifeSciences #MedicalDevices #SportsMedicine #Orthopedics #Surgeons evergenbio.com Listen to the podcast here
It is a Reboot Special with one of our faves - Dr. Brian Cole!Today's episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox.
شرکت ریجن آلوگرافت (فرآورده بافت ایرانیان) داره روی فرآوری بافتهایی کار میکنه که از بدن آدمهایی که دیگه زنده نیستن گرفته میشه. اونا از پزشک قانونی، اندامها و قسمتهایی از بدن رو دریافت میکنن تا از اونا برای تولید محصولاتشون استفاده کنن. محصولاتی که قراره دوباره به بدن آدمهای دیگه پیوند یا توی عملهای مختلف ازشون استفاده بشه. فوربو اینسایدر سوم؛ داستان ریجن آلوگرافت.این قسمت از پادکست فوربو با همکاری پارک فناوری پردیس منتشر میشه.منطقه بینالمللی نوآوری ایران | iiid.techلینک یوتوب فوربوhttps://youtube.com/@furbodm فوربو در اینستاگرام (@furbodm)فوربو در توییتر (@FurboPodcast) لینک حمایت مالی | https://furbodm.com/plus/برای خوندن مقالات حوزهی دیجیتال مارکتینگ به سایت فوربو سر بزنیدhttps://furbodm.com/صفحه اختصاصی پادکست فوربو در سایتhttps://furbodm.com/podcast/بلاگ شخصی من – رضا توکلیRezaTavakoli.comاینستاگرام (@r.t98)توییتر (@RezaTavakoli98) Hosted on Acast. See acast.com/privacy for more information.
In this show we have Dr. Gregory Nicholson from Rush University (Chicago, USA) who presents a study where they used preshaped and predrilled bone grafts to address shoulder instability. Jörn Kircher from Germany is my SECEC expert today who will ask the right questions to get deeper into this topic - Enjoy! Music under CC Licence: Artist: Malyssa Bellarosa Title: PretendArtist: Dr. Turtle Title: Which that is this?
Welcome to Season 2 of the Orthobullets Podcast. Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. Cliff Tribus and is titled Spinal Interbody Alternatives: Allograft Bone. Today's episode will be sponsored by the 28th Annual Selby Spine Conference, taking place Jan 29th - Feb 01st, 2025 in Park City, UT. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube
Łąkotka jest bardzo ważną strukturą stawu kolanowego. Urazy i przeciążenia kolana doprowadzają do jej uszkodzenia, co w rezultacie może spowodować zmiany zwyrodnieniowe stawu, ból, wysięki, ograniczenia w aktywności, a wreszcie konieczność wymiany stawu na protezę. Perspektywa straszna. Dzisiaj spróbuję przeanalizować, czy w takim razie łąkotkę można wymienić…
JACC Heart Failure Associate Editor Sean Pinney, MD, discusses a recently published original research paper that explores the results of a randomized controlled trial to test whether evolocumab reduces the burden of cardiac allograft vasculopathy.
Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern. In conclusion, FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity. Click here to read the article.
Today's episode is going to focus on osteochondral allograft transplantation, and specifically how basic science research can and should impact your clinical practice.We are joined today by Dr. Brian Cole, a Professor of Orthopedic Surgery and Chair of the Department of Orthopedic Surgery at Rush University Medical Center, Chair of Surgery at Rush Oak Park Hospital and Section Head of the Rush Cartilage Restoration Center. He is also a past president of the Arthroscopy Association of North America and a team physician for the Chicago Bulls and Chicago White Sox. So, without further ado, let's get to the Field House!
Dr. Medhat Askar joins the podcast to discuss the utility and validation of donor-derived cell-free DNA (dd-cfDNA) testing for solid-organ recipients. Dr. Askar also discusses the regulatory status of dd-cfDNA in the United States.
OCD Lesions are unique injuries to both cartilage and bone and not only occur in adults, but also often occur in the bodies of today's youth. It's time to find out more from a series of answers, details and lightbulb-conjuring lessons from 3 orthopedic surgeons inside this episode of The 6 to 8 Weeks Podcast. Connect with The 6-8 Weeks Podcast: There's a LOT of detail included in this program. Do you want to share YOUR perspective about it? Connect with The 6-8 Weeks Podcast Now! Subscribe to, Like and Share The 6-8 Weeks Podcast Everywhere: The Detailed Shownotes for This Episode of The 6-8 Weeks Podcast: -- -- What is an Osteochondrial Lesion? https://www.sportsmedicinenewyork.com/osteochondral-lesions-ankle-ankle-orthopedic-foot-ankle-surgeon-new-york-ny.html -- What is Cartalige? https://my.clevelandclinic.org/health/body/23173-cartilage -- What is Bone? https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/bones -- What is an X-Ray? https://my.clevelandclinic.org/health/diagnostics/21818-x-ray -- What is the Capitellum? https://radiopaedia.org/articles/capitellum Timestamps for This Episode of The 6-8 Weeks Podcast: 00:00 Knee pain and swelling, potentially from injury or degeneration. It can manifest as weakness and restricted motion, possibly due to a loose piece in the joint. 06:10 Ankle injuries can occur traumatically or atraumatically, with ankle sprains often affecting the outside or inside part of the talus bone. Treatment options for knee and elbow injuries are generally effective, but data for ankle osteochondral defects (OCDs) remains limited, and the appropriate treatment approach is still unclear. 08:44 Smaller knee lesions located in atypical areas have a better chance of healing, as they are not subjected to as much stress. However, lesions in common high-stress areas, such as the medial part of the knee, may struggle to heal. Non-operative treatments like bracing may be challenging for active children, leading some families to opt for early surgical intervention, particularly for older children, to avoid a long drawn-out treatment process. 11:02 Kids' cartilage repair relies on piece condition and age, with early intervention yielding higher success rates. However, invasive techniques may not be worth the risk. 13:54 Allograft is recommended for larger, younger lesions. Seek medical advice if symptoms worsen, even in younger individuals. Various treatment options are available. Expert guidance is crucial due to the complexity and conflicting information online. Connect with the Hosts of The 6-8 Weeks Podcast: It's never been easier to connect with the hosts of The 6-8 Weeks Podcast. Read on below to share your perspectives on this episode of The 6-8 Weeks Podcast. === Connect with Dr. Brian Feeley: On the Web -- On X === Connect with Dr. Nirav Pandya: On the Web:-- On X: === Connect with Dr. Drew Lansdown: On the Web
Human tissue is amazing. To think that a section of it can be harvested - whether it be your own or from another source, to change the future movement that will propel your body, career choices and life, makes the mind reel. It's time to learn what three orthopedic surgerons think about the various types of ACL grafts that can be made (patellar, hamstring and quadricep) to impact patients of all kinds inside this episode of The 6 to 8 Weeks Podcast. Connect with The 6-8 Weeks Podcast: There's a LOT of detail included in this program. Do you want to share YOUR perspective about it? Connect with The 6-8 Weeks Podcast Now! Subscribe to, Like and Share The 6-8 Weeks Podcast Everywhere: The Detailed Shownotes for This Episode of The 6-8 Weeks Podcast: -- What is the UCL? https://www.nationwidechildrens.org/conditions/ulnar-collateral-ligament-injury -- What is the ACL? https://kidshealth.org/en/teens/acl-injuries.html -- What is the MCL? https://kidshealth.org/en/teens/mcl-injuries.html -- What is a Graft? The process of a soft tissue graft involves collecting a small amount of tissue from another area within your mouth and placing it in the recessed area. During this procedure, the patient is given a local anesthetic to provide comfort and can choose to have nitrous oxide (laughing gas) to help them relax further -- What is a Patella? https://my.clevelandclinic.org/health/body/25038-patella -- What is a Hamstring? https://my.clevelandclinic.org/health/body/21904-hamstring-muscles -- What is a Quadricep? https://www.physio-pedia.com/Quadriceps_Muscle -- How Important is The Human Knee? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178997/ -- Who is Martha Murray? https://www.childrenshospital.org/directory/martha-murray -- What is the Boston Children's Health Physicians? https://bchp.childrenshospital.org/ -- What is Gore-Tex? https://www.gore-tex.com/technology/gore-tex-products -- What is Synovial Fluid? https://medlineplus.gov/lab-tests/synovial-fluid-analysis/ -- What is Autograft Tissue? https://www.sciencedirect.com/topics/medicine-and-dentistry/autograft -- What is Allograph Tissue? https://intermountainhealthcare.org/ckr-ext/Dcmnt -- What is the Difference Between a Tendon and a Ligament? https://medlineplus.gov/ency/imagepages/19089.htm#:~:text=Overview,move%20the%20bone%20or%20structure. -- A Listing of Peroneal Tendon Syndromes? -- What is a Biologic Scaffold? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580515/ -- Cadaver Tissue Donation: A Pathologist's Perspective: https://jme.bmj.com/content/29/3/135 -- Are Donor Tissues and Grafts Safe? https://www.verywellhealth.com/are-donor-tissues-and-grafts-safe-2549895 -- What Does It Mean to Be Skeletally Mature? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5257250/ Timestamps for This Episode of The 6-8 Weeks Podcast: 05:17 Options: - ACL surgery: autograft or allograft tissue - Autograft is from your own tissue - Allograft comes from cadaver donor tissue 06:49 Biologic scaffold supports new ligament growth effectively. 12:11 Allograft may fail due to early activity. 14:10 Drew's research identifies bone shape ACL risk. 18:52 Study results and surgeon's expertise matter. 22:07 Choice of graft depends on growth plate status. 23:02 Hamstrings preferred for young patients with ACL. Connect with the Hosts of The 6-8 Weeks Podcast: It's never been easier to connect with the hosts of The 6-8 Weeks Podcast. Read on below to share your perspectives on this episode of The 6-8 Weeks Podcast. === Connect with Dr. Brian Feeley: On the Web -- On X === Connect with Dr. Nirav Pandya: On the Web:-- On X: === Connect with Dr. Drew Lansdown: On the Web
On this episode, we're going to continue our discussion with Dr. William Bugbee and focus on OCA surgical technique and then discuss clinical outcomes including return to sports.Our conversation picks back up with a recent paper from the July issue of Cartilage this year titled “Young Age and Concomitant or Prior Bony Realignment Procedures are Associated with Decreased Risk of Failure of Osteochondral Allograft Transplantation in the Knee.” This retrospective nationwide database study represents the largest OCA cohort study to date and found that less than 2% of patients required salvage surgery. Young age, less than 29, and having a bony realignment procedure were associated with a significantly lower rate of salvage surgery – include revision cartilage procedures and arthroplasty.We finish up today with an article from the June 2017 issue of AJSM titled “Return to Sport and Recreational Activity after Osteochondral Allograft Transplantation in the Knee.” Dr. Bugbee and colleagues at Scripps Clinic in La Jolla California reported that at a mean follow up of 6 years, 75% of patients were able to return to sport or recreational activity. Patients who did not return were more likely to be female and have a large graft size. 25% of knees underwent further surgery and 9% were considered allograft failures. Of the patients without OCA failure, 91% were satisfied with the results of surgery.
On today's episode we're focusing on osteochondral allograft transplantation or “OCA” with Dr. William Bugbee. We have some great articles for you that contribute well to our conversation on OCA, including allograft preparation and storage, graft choice, surgical technique, clinical outcomes of OCA and return to sport. We'll start off our discussion today with an article authored by our guest, Dr. William Bugbee, from the May 2022 issue of AJSM titled “Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature.” There was significant variability in experimental designs and incomplete reporting across the studies, so no real conclusions could be drawn regarding optimal storage conditions. While 60% of animal model studies suggest storage time may impact outcomes and 80% indicate inferior outcomes with frozen OCA compared to fresh OCA, the authors note that 75% of clinical studies reported no correlation between storage time and outcomes. So, we have a lot left to learn here.Then, from the March 2022 issue of AJSM, we review an article titled “Association of Sex Mismatch Between Donor and Recipient With Graft Survivorship at 5 Years After OCA Transplantation.” Dr. Gomoll and colleagues at Brigham and Women's reported that a significantly lower rate of graft survival was observed after different sex donor-recipient transplant compared to same sex donor-recipient OCA – 63% compared to 92%. Patients who received a donor-recipient sex-mismatch transplantation were 2.9X more likely to fail. Male donor to female recipient demonstrated the highest likelihood of failure compared to all other combinations.We are joined today by Dr. William Bugbee, a board-certified orthopedic surgeon specializing in joint reconstruction and cartilage restoration at Scripps Clinic in La Jolla, California. Dr. Bugbee received his medical degree from UC San Diego and remained at UC San Diego for his orthopedic surgery residency. He then went on to complete a fellowship in joint reconstruction at the Anderson Orthopaedic Research Institute. Dr. Bugbee has published extensively on the topic of osteochondral allograft transplantation, so we're very excited that he is joining us today to share his expertise with all of you!
In this episode of Behind the Knife the vascular surgery subspecialty team discusses a case of an infected endovascular aortic graft. Although rare, aortic graft infections remain a devastating complication. What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, how they present, and what options you have to fix it. Hosts: Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. David Schechtman is a Vascular Surgery Fellow at the University of Michigan Dr. Drew Braet is a PGY-3 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives · Understand the incidence of and the relevant risk factors for aortic graft infections · Review the spectrum of presenting symptoms and relevant workup for aortic graft infections · Understand surgical treatment options including options for in-situ bypass and extra-anatomic bypass · Review the different conduits that can be used for in-situ and extra-anatomic reconstruction · Discuss relevant post-operative considerations for patients undergoing operative intervention for aortic graft infection References · Chiesa R, Astore D, Frigerio S, Garriboli L, Piccolo G, Castellano R, Scalamogna M, Odero A, Pirrelli S, Biasi G, Mingazzini P, Biglioli P, Polvani G, Guarino A, Agrifoglio G, Tori A, Spina G. Vascular prosthetic graft infection: epidemiology, bacteriology, pathogenesis and treatment. Acta Chir Belg. 2002 Aug;102(4):238-47. doi: 10.1080/00015458.2002.11679305. PMID: 12244902. · Bisdas T, Bredt M, Pichlmaier M, Aper T, Wilhelmi M, Bisdas S, Haverich A, Teebken OE. Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg. 2010 Aug;52(2):323-30. doi: 10.1016/j.jvs.2010.02.277. Epub 2010 Jun 8. PMID: 20570473. · PereraG. B.FujitaniR. M.KubaskaS. M.2006Aortic graft infection: Update on Management and Treatment Options.Vasc Endovascular Surg, 401Jan), 1101538-5744 · Hallett J., Marshall D.M., Petterson T.M., et. al.: Graft-related complications after abdominal aortic aneurysm repair: Population-based experience. J Vasc Surg 1977; 25: pp. 277-284. · Kieffer E, Sabatier J, Plissonnier D, Knosalla C. Prosthetic graft infection after descending thoracic/ thoracoabdominal aortic aneurysmectomy: management with in situ arterial allografts. J Vasc Surg. 2001 Apr;33(4):671-8. doi: 10.1067/mva.2001.112314. PMID: 11296316. · Gutowski P. Zakazenie aortalno-biodrowej protezy naczyniowej jako problem diagnostyczny i leczniczy [Aortoiliac graft infection as a diagnostic and treatment problem]. Ann Acad Med Stetin. 1998;Suppl 41:1-72. Polish. PMID: 9766086. · Capoccia L, Mestres G, Riambau V. Current technology for the treatment of infection following abdominal aortic aneurysm (AAA) fixation by endovascular repair (EVAR). J Cardiovasc Surg (Torino). 2014;55:381–389. · Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. Aorta (Stamford). 2014 Dec 1;2(6):255-64. doi: 10.12945/j.aorta.2014.14-036. PMID: 26798744; PMCID: PMC4682678. · Reinders Folmer E.I., Von Meijenfeldt G.C.I., Van der Laan M.J., Glaudemans A.W.J.M., Slart R.H.J.A., Saleem B.R., Zeebregts C.J. Diagnostic Imaging in Vascular Graft Infection: A Systematic Review and Meta-Analysis. Eur. J. Vasc. Endovasc. Surg. 2018;56:719–729. doi: 10.1016/j.ejvs.2018.07.010. · Rafailidis V., Partovi S., Dikkes A., Nakamoto D.A., Azar N., Staub D. Evolving clinical applications of contrast-enhanced ultrasound (CEUS) in the abdominal aorta. Cardiovasc. Diagn. Ther. 2018;8:S118–S130. doi: 10.21037/cdt.2017.09.09. · Hayes P.D., Nasim A., London N.J., et. al.: In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: The Leicester experience (1992 to 1998). J Vasc Surg 1999; 30: pp. 92-98. · Oderich GS, Bower TC, Hofer J, Kalra M, Duncan AA, Wilson JW, Cha S, Gloviczki P. In situ rifampin-soaked grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with aortic graft enteric erosion or fistula. J Vasc Surg. 2011 Jan;53(1):99-106, 107.e1-7; discussion 106-7. doi: 10.1016/j.jvs.2010.08.018. PMID: 21184932. · Bisdas T., Bredt M., Pichlmaier M., et. al.: Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg 2010; 52: pp. 323-330. · O'Hara P.J., Hertzer N.R., Beven E.G., et. al.: Surgical management of infected abdominal aortic grafts: Review of a 25-year experience. J Vasc Surg 1986; 3: pp. 725-731. · Quiñones-Baldrich WJ, Hernandez JJ, Moore WS. Long-term Results Following Surgical Management of Aortic Graft Infection. Arch Surg. 1991;126(4):507–511. doi:10.1001/archsurg.1991.01410280111018 · Kieffer E., Gomes D., Chieche L., et. al.: Allograft replacement for infrarenal aortic graft infection: Early and late results in 179 patients. J Vasc Surg 2004; 39: pp. 1009-1017. · Zhou W., Lin P.H., Bush R.L., et. al.: In situ reconstruction with cryopreserved arterial allografts for management of mycotic aneurysms or aortic prosthetic graft infections: A multi-institutional experience. Texas Heart Institute J 2006; 33: pp. 14-18. 2006 · Ali AT, Modrall JG, Hocking J, Valentine RJ, Spencer H, Eidt JF, Clagett GP. Long-term results of the treatment of aortic graft infection by in situ replacement with femoral popliteal vein grafts. J Vasc Surg. 2009 Jul;50(1):30-9. doi: 10.1016/j.jvs.2009.01.008. PMID: 19563952. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other vascular episodes here: https://behindtheknife.org/podcast-category/vascular/
This month on Episode 45 of Discover CircRes, host Cynthia St. Hilaire highlights four original research articles featured in the February 3rd and February 17th issues of Circulation Research. This episode also features an interview with Dr Hind Lal and Dr Tousif Sultan from the University of Alabama at Birmingham about their study Ponatinib Drives Cardiotoxicity by S100A8/A9-NLRP3-IL-1β Mediated Inflammation. Article highlights: Pi, et al. Metabolomic Signatures in PAH Carnevale, et al. Thrombosis TLR4-Mediated in SARS-CoV-2 Infection Cai, et al. Macrophage ADAR1 in AAA Koide, et al. sEVs Accelerate Vascular Calcification in CKD Cindy St. Hilaire: Hi, and welcome to Discover CircRes, the podcast of the American Heart Association's journal, Circulation Research. I'm your host, Dr Cynthia St. Hilaire from the Vascular Medicine Institute at the University of Pittsburgh, and today I'm going to be highlighting the articles from our February 3rd and 17th issues of Circulation Research. I'm also going to have a chat with Dr Hind Lal and Dr Tousif Sultan from the University of Alabama at Birmingham about their study, Ponatinib Drives Cardiotoxicity by S100A8/A9-NLRP3-IL-1β Mediated Inflammation. But before I get to the interviews, here are a few article highlights. Cindy St. Hilaire: The first article I want to highlight comes from the laboratory of Dr Peter Leary at the University of Washington, and the title is Metabolomic Signatures Associated With Pulmonary Arterial Hypertension Outcomes. Pulmonary Arterial Hypertension or PAH is a rare but life-threatening disease in which progressive thickening of the walls of the lung's blood vessels causes increased blood pressure and that increased blood pressure ultimately damages the heart's right ventricle. Interestingly, progression to heart failure varies considerably among patients, but the reasons why there is variability are not well understood. To find out, this group turned their attention to patient metabolomes, which differ significantly from those of healthy people and thus may also change with severity. Blood samples from 117 PAH patients were analyzed for more than a thousand metabolites by mass spectrometry and the patient's progress was followed for the next three years. 22 patients died within a three-year period and 27 developed significant right ventricle dilation. Other measures of severity included pulmonary vascular resistance, exercise capacity and levels of BNP, which is a metric of heart health. Two metabolic pathways, those relating to polyamine and histidine metabolism, were found to be linked with all measures of severity suggesting a key role for them in disease pathology. While determining how these pathways influence disease as a subject for further study, the current findings may nevertheless lead to new prognostic indicators to inform patient care. Cindy St. Hilaire: The next article I want to discuss is coming from our February 3rd issue of Circulation Research and this is coming from the laboratory of Dr Francisco Violi at the University of Rome and the title is Toll-Like Receptor 4-Dependent Platelet-Related Thrombosis in SARS-CoV-2 Infection. Thrombosis can be a complication of COVID-19 and it is associated with poor outcomes, including death. However, the exact mechanism by which the virus activates platelets, which are the cells that drive thrombosis, is not clear. For one thing, platelets do not appear to express the receptor for SARS-CoV-2. They do however, express the TLR4 receptor and that's a receptor that mediates entry of other viruses as part of the immune response. And TLR4 is ramped up in COVID-19 patient platelets. This group now confirms that, indeed, SARS-CoV-2 interacts with TLR4, which in turn triggers thrombosis. The team analyzed platelets from 25 patients and 10 healthy controls and they found that the platelet activation and thrombic activity were both boosted in the patient samples and could not be blocked using a TLR4 inhibitor. Additionally, immunoprecipitation and immunofluorescent experiments further revealed colocalization between the virus protein and the TLR4 receptor on patient platelets. The team went on to show that the signaling pathway involved reactive oxygen species producing factors p47phox and Nox2, and that inhibition of phox 47, like that of the TLR4 receptor itsel,f could prevent platelet activation. As such, this study suggests that inhibiting either of these proteins may form the basis of an antithrombotic treatment for COVID-19. Cindy St. Hilaire: The third article I want to highlight is coming from the lab of Shi-You Chen at University of Missouri and the title of this article is ADAR1 Non-Editing Function in Macrophage Activation and Abdominal Aortic Aneurysm. Macrophage activation plays a critical role in abdominal aortic aneurysm development, or AAA development. Inflammation is a component of this pathology; however, the mechanisms controlling macrophage activation and vascular inflammation in AAA are largely unknown. The ADAR1 enzyme catalyzes the conversion of adenosine to inosine in RNA molecules and thus this conversion can serve as a rheostat to regulate RNA structure or the gene coding sequence of proteins. Several studies have explored the role of ADAR1 in inflammation, but its precise contribution is not fully understood, so the objective of this group was to study the role of ADAR1 in macrophage activation and AAA formation. Aortic transplantation was conducted to determine the importance of nonvascular ADAR1 in AAA development and dissection and angiotensin II infusion of ApoE knockout mice combined with a macrophage specific knockout of ADAR1 was used to study the role of ADAR1 macrophage specific contributions to AAA formation and dissection. Allograft transplantation of wild type abdominal aortas to ADAR1 haploinsufficient recipient mice significantly attenuated AAA formation. ADAR1 deficiency in hematopoietic stem cells also decreased the prevalence and the severity of AAA and it also inhibited macrophage infiltration into the aortic wall. ADAR1 deletion blocked the classic macrophage activation pathway. It diminished NF-κB signaling and it enhanced the expression of a number of anti-inflammatory microRNAs. Reconstitution of ADAR1 deficient but not wild type human monocytes to immunodeficient mice blocked the aneurysm formation in transplanted human arteries. Together these results suggest that macrophage ADAR1 promotes aneurysm formation in both mouse and human arteries through a novel mechanism of editing the microRNAs that target NF-κB signaling, which ultimately promotes vascular inflammation in AAA. Cindy St. Hilaire: The last article I want to highlight is also from our February 17th issue of Circulation Research and it is coming from the lab of Shintaro Mandai at Tokyo Medical and Dental University and the title of the article is Circulating Extracellular Vesicle Propagated MicroRNA signatures as a Vascular Calcification Factor in Chronic Kidney Disease. Chronic Kidney Disease or CKD accelerates vascular calcification in part by promoting the phenotypic switching of vascular smooth muscle cells to osteoblast like cells. This study investigated the role of circulating small extracellular vesicles or SUVs from the kidneys in promoting this osteogenic switch. CKD was induced in rats and in mice by an adenine induced tubular interstitial fibrosis and serum from these animals induced calcification in in vitro cultures of A-10 embryonic rat smooth muscle cells. Intraperitoneal administration of a compound that prevents SEV biosynthesis and release inhibited thoracic aortic calcification in CKD mice under a high phosphorus diet. In Chronic Kidney Disease, the microRNA transcriptome of SUVs revealed a depletion of four microRNAs and the expression of the microRNAs inversely correlated with kidney function in CKD patients. In vitro studies found that transected microRNA mimics prevented smooth muscle cell calcification in vitro. In silico analyses revealed that VEGF-A was a convergent target of all four microRNAs and leveraging this, the group used in vitro and in vivo models of calcification to show the inhibition of the VEGF-A, VEGFR-2 signaling pathway mitigated calcification. So in addition to identifying a new potential therapeutic target, these SUV propagated microRNAs are a potential biomarker that can be used for screening patients to determine the severity of CKD and possibly even vascular calcification. Cindy St. Hilaire: Today I have with me Dr Hind Lal who's an associate professor of medicine at the University of Alabama Birmingham and his post-doctoral fellow and the lead author of the study Dr Tousif Sultan. And their manuscript is titled Ponatinib Drives Cardiotoxicity by S100A8/A9-NLRP3-IL-1β Mediated Inflammation. And this article is in our February 3rd issue of Circulation Research. So thank you both so much for joining me today. Tousif Sultan: Thank you. Hind Lal: Thank you for taking time. Cindy St. Hilaire: So ponatinib, it's a tyrosine kinase inhibitor and from my understanding it's the only treatment option for a specific group of patients who have chronic myelogenous leukemia and they have to harbor a specific mutation. And while this drug helps to keep these patients alive essentially, it's extremely cardiotoxic. So cardiotoxicity is somewhat of a new field. So Dr Lal, I was wondering how did you get into this line of research? Hind Lal: So I was fortunate enough to be in the lab of Dr Tom Force and he was kind of father of this new area, now is very developed, it's called cardio-oncology. On those days there were basically everything started in cardio-oncology. So I just recall the first tyrosine kinase approved by FDA was in 2000 and that was... Imagine and our paper came in Nature Medicine 2005 and discovering there is... so to elaborate it a little bit, the cancer therapy broadly divided in two parts. One is called non-targeted therapy like chemotherapy, radiations, et cetera, and then there are cytotoxic drugs. So those cytotoxic drugs because they do not have any targeted name on it so they are, cardiotoxic are toxic to any organ was very obvious and understanding. When these targeted therapy came, which is mainly kinase inhibitor are monoclonal antibodies. So these are targeted to a specific pathway that is activated only in the cancer cells but not in any other cells in the body so they were proposed as like magic bullets that can take off the cancer without any cardiotoxity or minimal side effects. But even in the early phase like 2005 to 2010, these came out, these so-called targeted, they are not very targeted and they are not also the magic bullets and they have serious cardiotoxicity. Cindy St. Hilaire: And so what's the mechanism of action of ponatinib in the leukemia and how does that intersect with the cardiovascular system? Hind Lal: Yeah, so this is very good question I must say. So what we believe at this point because, so leukemia if you know is driven by the famous Philadelphia chromosome, which is a translicational gene, one part of human chromosome nine and one part of human chromosome 22 and they translocate make a new gene which is BCR-ABL gene. And because it was discovered in Philadelphia UPENN, is named that Philadelphia chromosome, which is very established mechanism, that's how CML is driven. But what we have discovered that the cardiotoxicity driven by totally, totally different from the ponatinib is one of the inflammatory So it's kind of goodening. So this question is so good. One kind of toxicity is called on-target, when toxicity is mediated by the same mechanism, what is the mechanism of the drug to cure the cancer? So in that case your absolute is minimal because if you manipulate that, the drug's ability to cure the cancer will be affected but if the toxicity and the efficacy is driven by two different mechanism, then as in case of ponatinib seems like it's NLRP3 and inflammasome related mechanism. So this can be managed by manipulating this pathway without hampering the drug efficacy on the cancer. Cindy St. Hilaire: So what exactly is cardiotoxicity and how does it present itself in these patients? Hind Lal: So these drugs like ponatinib, they call broader CVD effects. So it's not just cardiac, so they also in hypertensives and atherosclerosis and thrombosis, those kind of thing. But our lab is primarily focused on the heart. So that's why in this paper we have given impresses on the heart. So what we believe at this point that ponatinib lead to this proinflammatory pathway described in this paper, which is just 108A9-NLRP3-IL-1β and this inflammatory pathway lead to a cytokine storm very much like in the COVID-19 and these cytokine storms lead to excessive myocarditis and then finally cardiac dysfunction. Cindy St. Hilaire: Is the cytokine storm just local in the cardiac tissue or is it also systemic in the patients? Is cardiotoxicity localized only or is it a more systemic problem? Tousif Sultan: I would like to add in this paper we have included that we look this cytokine things and explain blood circulation, bone marrow. So the effect is everywhere, it's not local. So we didn't check other organs, maybe other organs also being affected with the ponatinib treatment. Cindy St. Hilaire: And what's the initial phenotype of a patient has when they start to get cardiotoxicity, what's kind of like a telltale symptom? Hind Lal: So good thing that in recent years cardio-oncology developed. So initially the patient that were going for cancer treatment, they were not monitored very closely. So they only end up in cardiology clinic when they are having some cardiac events already. So thanks to the lot of development and growth in the cardio-oncology field, now most patients who going for a long-term cancer treatment, they are closely monitored by cardiology clinics. Cindy St. Hilaire: Got it. So they can often catch it before a symptom or an event. That's wonderful. Hind Lal: Yeah, so there's a lot of development in monitoring. Cindy St. Hilaire: Wonderful. So you were really interested in figuring out why ponatinib induces cardiotoxicity and you mentioned that really up until now it's been very difficult to study and that's because of the limitation of available murine models. If you just inject a wild type mouse with ponatinib, nothing happens really. So what was your approach to finding relatively good murine models? How did you go about that? Hind Lal: So this is the top scientific question you can ask. So like science, the field is try and try again. So initially this is the first paper with the ponatinib toxicity using the real in vivo models. Any paper before this including ours studies published, they were done on the cellular model in hiPSC, that isolated cardiomyocytes. So you directly putting the ponatinib directly the isolated cells. So this is first case when we were trying to do in vivo, maybe other attempt in vivo but at least not published. So first we also treated the animals with ponatinib and that failed, we don't see any cardiotoxic effect. And then when we going back to the literature, the clinical data is very, very clear from pharmacovigilance that ponatinib is cardiotoxic in humans. So when we're not able to see any phenotype in mouse, we realize that we are not mimicking what's happening in the humans. So we certainly missing something. Now once again I quote this COVID-19, so many people get infected with COVID-19 but people are having preexisting conditions are on high risk to developing CVD. So there was some literature on that line. So we use this very, very same concept that if there is preexisting conditions, so likely who'd have developing future cardiac event will be more. So we use two model in this paper one atherosclerosis model which is APoE null mice mice, another is tag branding which is pressure overload model for the heart and as soon as we start using what we call comorbidity model like patient is having some preexisting conditions and we very clearly see the robust defect of ponatinib on cardiac dysfunction. Cindy St. Hilaire: Yeah, it's really, really well done and I really like that you use kind of two different models of this. Do you think it's also going to be operative in maybe like the diabetic mirroring models? Do you think if we expand to other comorbidities, you might also recapitulate the cardiotoxicity? Hind Lal: So you got all the best questions. Cindy St. Hilaire: Thank you. I try. Hind Lal: So because this is CML drug and lot of the risk factor for cardiovascular and cancer are common and even metabolic disease. So most of the time these patients are elderly patients and they're having metabolic conditions and most of the time they have blood pressure or something CVD risk factors. So I agree with you, it'll be very relevant to expand this to the diabetes or metabolic models, but these were the first study, we put all our focus to get this one out so news is there then we can expand the field adding additional models et cetera. But I agree with you that will be very logical next step to do. Cindy St. Hilaire: Yeah. And so I guess going back to what you know from the human study or the clinical trials or the human observations, are different populations of patients with CML more predisposed to cardio toxicity than others or is that not known yet? Hind Lal: So one other area called pharmacovigilance. So what pharmacovigilance does patient all over the world taking these drugs. So WHO have their own vigilance system and FDA have their own, so it's called BG-Base for the WHO and it's called the FAERS for the FDA. So one can go back in those data sets and see if X patient taking this Y drug and what kind of symptoms or adverse effect they are seeing and if these symptoms are associated with something else. So there is data that if patients having CVD risk factor, they are more prone to develop ponatinib induced cardiac events. But it needs more polish like you asked the just previous question, diabetes versus maybe blood pressure means hypertension, atherosclerosis, or thrombosis. So it has not been delineated further but in a one big bucket if patients are having CVD risk factor before they are more prone and more likely to develop the cardiac events. Cindy St. Hilaire: So after you established that these two murine models could pretty robustly recapitulate the human phenotype, what did you do next? How did you come upon the S100A8/A9-NLRP3-IL-1β signaling circuit? How did you get to that? Hind Lal: So in basic science work, whenever we do mouse is called until we get there is cardiac dysfunction, it's called phenotype, right? So mouse had a cardiac phenotype. So next step is, "Why? What is leading to that phenotype?" That's what we call mechanism. So there the best idea to fit the mechanism is using one of the unbiased approaches like you do unbiased proteomics, unbiased RNC analysis, something like this that will analyze the entire transcript like RNC and say, "Okay, these pathway are," then you can do further analysis that will indicate these pathway are different, are altered. So in this case we used RNC analysis and it came out that this yes A8 and yes A9, 100A8 and nine, they were the most upregulated in this whole set. And thereafter we were very lucky. So we started this study at Vanderbilt, where my lab was and thereafter we very lucky to move here and found Sultan who had a lot of experience with this inflammation and immune system and then Sultan may add something on this so he'll be the better person to say something on this. Tousif Sultan: So after our RNC analysis, so we got this S100A8 and nine as top hit with the ponatinib treatment. So then we validated this finding with our flow cytometric, qRT PCR aand then we started which pathway is going to release cytokine and all that. So we found that is NLRP3 inflammasome. Cindy St. Hilaire: Yeah and well and I guess maybe step back, what is S100A8/A9? What are those? Tousif Sultan: Yeah, S10A8/A9 is a calcium binding protein. So that's also called alarmin and they basically binds with the pathogen associated pattern and other TLR2 like receptors and then start inflammatory pathway to release cytokine and all that and it's stable in heterodimer form. So S100A8 heterodimer with A9 and then bind with TLR and a start in this inflammatory pathway. Cindy St. Hilaire: And what type of cell is that happening in? Is that happening in the immune cells only or is it also in the cardiomyocyte, or...? Tousif Sultan: Yeah, we have included all this data. So from where this alarmin is coming with ponatinib treatment, so literature also suggested that neutrophils and monocytes, those cells are the potential to release the alarmin. So here we also found these two type of cells, neutrophils and monocytes. They release huge alarmin with the treatment of ponatinib. Cindy St. Hilaire: And so really taking this really neat mechanism to the next level, you then tried attenuating it by using broad anti-inflammatory steroid dexamethasone but also by targeting these specific components, the NLRP and the S100A specific inhibitors and they worked well. It worked really nicely. Does your data show that any of these therapies work better than the other and then are these viable options to use in humans? Hind Lal: Yeah, we have some data in the paper. Are very broad which help a lot in COVID patients, far very acute infections. So in this case, situation is very different cause most of CML patients will going to take ponatinib for lifelong, there is no remission, right? So in those case, its certainly not a very attractive option. We have shown data in the paper that dexamethasone help with the heart but lead to some metabolic changes. So we have compared those with the NLRP3 inhibitors, those metabolic alterations, dexa versus the NLRP3 inhibitors, CY-09. And we demonstrated that targeting is specifically with paquinimod, our NLRP3 inhibitor CY-09, feel better. It can still rescue the cardiac phenotype without having those adverse effect on metabolic parameters. Cindy St. Hilaire: That's wonderful. Do you think though that because you have to take ponatinib for life, that long-term NLRP inhibition would also cause problems or...? Hind Lal: So because not every patient who taking ponatinib would develop the cardiac phenotype, right? Which is like a 10%, 12%, patient developing cardiac dysfunction. So I think someone like I strongly believe paquinimod, which is inhibitor of S100A9, will be really good option or at least we have enough data that make us nail for at least a small clinical trial. And we quickly moving on that. At UAB we have our clinical cardio-oncology program and we are already in touch with the director for the clinical cardio-oncology program. So what we trying to do in that small trial is if one of the standard therapy for heart like beta blocker or ARBs inhibitor, is there any preference like one work better than the other in the standard care? So first we doing that project, then we obviously looking forward if one small clinical trial can be done with paquinimod. I strongly believe it should be helpful. Cindy St. Hilaire: That is wonderful. And so do you think... There's other chemotherapeutic agents or probably even other non-cancer drugs that cause cardiotoxicity, do you think this mechanism, this pathway, this S100A-NLRP-IL-1β axis is operative in all cardiotoxicities or do you think it's going to be very specific to the ponatinib? Hind Lal: So it's certainly not all, but it'll be certainly more than ponatinib. So in our lab we are using another kinase inhibitor, which is osimertinib and it's not published yet, but now we know that it's also cardiotoxic because it's taking metabolic root or energetics disruption but not this pro-inflammatory part, but we're doing another project which is strep pneumonia induced cardiac dysfunction, which is called pneumonia. So strep pneumoniae, which leads to the pneumonia ,and lot patient die because of the failing heart we see here in the hospitals and we see these pathways operational over there and we gearing up to do clinical trial on that aspect as well, but it's not generalized like all kind of heart will have the same mechanism. Cindy St. Hilaire: It's wonderful to see you're already taking those next steps towards really kind of bringing this to a translational/clinical study. So what was the most challenging aspect of this study? Tousif Sultan: The challenging aspect, ponatinib is a kinase inhibitor and that was surprising for us how it's activating immune cells. Generally kinase inhibitors, inhibits all the cells like that. So that was challenging. So we repeated it many times did in vitro experiment to confirm that. So we just added, just treated in vitro immune cells with the ponatinib and confirmed it. So that was little challenging. Cindy St. Hilaire: So what's next? You mentioned you're going to try some clinical trials, early stage clinical trials. What's next mechanistically, what do you want to go after? Hind Lal: So what we are doing next and we are very, very eagerly trying to do that. So what it was done, we used the cardiac comorbidity models, but as you know, anybody who will take ponatinib will have cancer, right? So we strongly believe that we miss one factor. There was no cancer on these. So that is very logical next step. What that will allow us to do, what rescue experiment we'll have done in this paper. So we saw, "Okay, this rescue the cardiac phenotype, which is taken care of now," but very same time, we not able to demonstrate that this is happening without hurting the cancer efficacy. So if we have the dual comorbid mouse, which have CML a real thing and we have cardiac thing, then that will allow us to demonstrate, "Okay, we got something that can take care of the cardiac problem without hurting the efficacy on the cancer." And it will be best if you also help little bit to more potentiate the cancer efficacy. Cindy St. Hilaire: Yes. Excellent. Well, congratulations on a beautiful study, really exciting findings. Dr Lal and Dr Sultan, thank you so much for taking the time to talk with me today. Tousif Sultan: Thank you so much. Hind Lal: Well thank you, Cynthia. We really appreciate your time. Thank you for having us. Cindy St. Hilaire: Yeah, it was great. Cindy St. Hilaire: That's it for our highlights from the February 3rd and February 17th issues of Circulation Research. Thank you so much for listening. Please check out the Circulation Research Facebook page and follow us on Twitter and Instagram with the handle @CircRes and #DiscoverCircRes. Thank you to our guests, Dr Hind Lal and Dr Tousif Sultan. This podcast is produced by Ishara Ratnayake, edited by Melissa Stoner and supported by the editorial team at Circulation Research. Some of the copy text for the highlighted articles was provided by Ruth Williams. I'm your host, Dr Cynthia St. Hilaire, and this is Discover CircRes, you're on-the-go source for most exciting discoveries in basic cardiovascular research. This program is copyright of the American Heart Association 2023. And the opinions expressed by the speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more information, please visit ahajournals.org.
Cardiac Allograft Rejection Using AI-ECG Guest: Demilade A. Adedinsewo, M.B., Ch.B., M.P.H. Hosts: Anthony H. Kashou, M.D. (@anthonykashoumd) Joining us today to discuss cardiac allograft rejection using AI-ECG is Demilade A. Adedinsewo, M.B., Ch.B., M.P.H., assistant professor of medicine and non-invasive cardiologist at Mayo Clinic, Florida. Her research interests include the application of artificial intelligence tools in cardiology. Specific topics discussed: In order to introduce this project to our listeners, can you tell us a bit about why this study is important? Can you describe the steps involved in developing this project? Could you share the summary results from your study? What are the potential implications of your findings for patient care? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. Facebook: MayoCVservices LinkedIn: Mayo Clinic Cardiovascular Services NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
• Host Austin Beason, MD • Articles summarized from the January 15, 2022 issue (https://journals.lww.com/Jaaos/toc/2023/01150) o Research article “Documented Penicillin Allergies Should Not Preclude Use of Pre-Operative Cefazolin in Hip and Knee Arthroplasty” o Research article “Assessing Leg Length and Offset in Anterior Total Hip Arthroplasty: Overlay versus AP Pelvis Intraoperative Radiographic Techniques” o Research article “Outcomes of Plug Osteochondral Allograft Transplantation with or without Concomitant Osteotomy for Cartilage Defects in the Knee: Minimum 2-year Follow-up” Follow this link to download these and other articles from the January 1, 2023 issue of JAAOS (https://journals.lww.com/Jaaos/toc/2023/01010) and the January 15, 2023 issue of JAAOS (https://journals.lww.com/Jaaos/toc/2023/01150). The JAAOS Unplugged podcast series is brought to you by the Journal of the American Academy of Orthopaedic Surgeons and the AAOS Resident Assembly.
Commentary by Dr. Valentin Fuster
Riz Hatton talks about what's new in the Spine and Orthopedic industry.
Welcome to The Sports Docs Podcast with Dr. Catherine Logan and Dr. Ashley Bassett. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.On today's episode we're focusing on cartilage defects of the knee with Dr. Clayton Nuelle, Assistant Clinical Professor at the University of Missouri and team physician for Mizzou athletics. His current research focuses on improving cartilage restoration and joint preservation techniques, so we are very excited to have him join us for our discussion today.We have some great articles for you that contribute well to our conversation on the surgical treatment of knee cartilage disease. The first article is a level I prospective RCT published in the May 2018 issue of AJSM titled “Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture – Five Year Follow-up of a Prospective Randomized Trial.” This multicenter study was performed at 14 sites across 7 different countries. Patients with symptomatic full thickness cartilage defects greater than 3 cm in size and involving the femoral condyle or trochlea were randomized to either the MACI procedure or microfracture procedure. If you're not familiar with the MACI procedure, we definitely recommend checking out our last Overtime episode where we do a deep dive into the details of that surgical technique. In this 5-year clinical trial, Brittberg and colleagues found that while both groups significantly improved after surgery, patients who underwent the MACI procedure were both clinically and statistically significantly better at 5 years compared to patients who underwent microfracture.Then, from the February issue of AJSM this year, we review the publication titled “Isolated Osteochondral Autograft versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee.” Bryan Saltzman and his team at OrthoCarolina performed a systematic review of Llevel I and II studies investigating osteochondral transplant techniques. For our listeners, osteochondral transplants can be performed using autograft – the patient's own tissue, or allograft – donor tissue. Traditionally, autograft transplant or “OATs” has been used for smaller defects, to minimize donor-site morbidity, and has the benefits of avoiding an immune response and no concern for disease transmission.The osteochondral graft is typically harvested from nonweightbearing areas of the knee, such as the intercondylar notch or supracondylar ridge. Allograft transplant or “OCA” is indicated for larger defects. Benefits include the lack of donor site morbidity and the ability to take a graft from an area that correlates with the defect being addressed, such as patella to patella. Grafts can also be size-matched during the ordering process. Downsides include having to wait for allograft availability and cost, in addition to the immunologic and disease transmission risks already discussed, though those are very rare. Both techniques have the benefit of addressing not only the cartilage disease but also underlying bone loss. This systematic review concluded that both OATs and OCA resulted in favorable patient outcomes and graft survival rates at 5-year follow up, with no significant differences between the two. The autograft group was significantly younger, had smaller defect size, used a larger number of plugs and more frequently treated medial femoral condyle lesions. The allograft group had a larger number of patients with lateral femoral condyle and trochlear lesions.
Dr. Briggs summarizes findings in a study published in the June issue of JASN. The study examines the impact of continued immunosuppression in patients with failed allografts; the effects are surprising and suggest current guidelines may not be optimum.
In this episode we take you through an approach to the kidney transplant patient presenting with acute allograft dysfunction. We will cover differential, key questions on history, and an overview to management. Written by Dr. Susan Thanabalasingam (Internal Medicine Resident)Reviewed by Dr. Khaled Shamseddin (Nephrologist) and Dr. David Taylor (General Internist)
In cases of tibialis anterior tendon (TAT) ruptures associated with significant tendon defect, an interposition graft is often needed for reconstruction. Both auto- and allograft reconstructions have been described in the literature. Our hypothesis was that both graft types would have a good integrity and provide comparable outcomes. In conclusion, reconstructions of TAT achieved good PROs, as well as functional and imaging results with a preserved graft integrity in all cases. There were no substantial differences between allograft and autograft reconstructions. To view the article click here.
Commentary by Dr. Valentin Fuster
Drs Dekker and Provencher discuss Distal Tibia Allograft Glenoid Reconstruction in Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes
W gabinecie, kiedy tylko kieruję kogoś na operację rekonstrukcji więzadła krzyżowego przedniego, od razu pada pytanie o to, jak przebiega zabieg. No i jak tu wybrąć z sytuacji? Opowiedzenie pacjentowi jak cały zabieg będzie wyglądał zajmuje sporo czasu, a w czasie konsultacji czas mamy limitowany. A tu jeszcze trzeba wszystkie dokumenty wystawić. W tym odcinku pacjent może posłuchać sobie, jak taki zabieg będzie wyglądał. Omawiam ogólnie jakie kroki trzeba po kolei wykonać aby zabieg przeprowadzić, ale przybliżam również techniki poszczególnych etapów. Pod koniec nagrania jest również coś o konieczności (lub jej braku) usuwania implantów oraz o czasie takiej operacji.
This week we delve into the world of heart transplantation and echocardiography to review a recent work on non-invasive assessment of the pediatric heart transplant patient. Can stress echo and real time myocardial contrast echo identify coronary vasculopathy in this patient group? How do the results compare to coronary angiography? How difficult is this form of imaging and can it be done by pediatric echo techs and staff physicians? Professor Jonathan N. Johnson of the Mayo Clinic shares his insights this week. DOI: 10.1016/j.echo.2020.12.009
Drs Nuelle and Levy discuss the Editorial Commentary: Autograft Beats Allograft For Most Knee Ligament Surgery
Previous studies have demonstrated success in using autogenous bone graft for arthrodesis in patients with failed surgeries of the hallux. These patients have several causes for pain and dysfunction preoperatively, including a shortened first ray, nonunion, and poor hallux alignment. In conclusion, the use of an interposition patellar wedge allograft can restore length to the first ray and provide successful salvage of arthrodesis nonunions and bone loss from failed hemiarthroplasty and total joint implants of the great toe MP joint. To view the article click here.
Download Show Notes at: www.naileditortho.com/tkaextensor Dr. Antonia Chen, who specializes in hip and knee replacements, is the Director of Research for the Division of Adult Reconstruction and Total Joint Arthroplasty at the Department of Orthopaedic Surgery at Brigham and Women's Hospital (BWH) and Associate Professor of Orthopaedic Surgery at Harvard Medical School. She is a certified Orthopaedic Surgeon by the American Board, and her professional practice focuses on patients with arthritic hips and knees, as well as avascular necrosis. She also specializes in the management of complicated patients who may require revision surgery or further therapy for earlier hip and knee surgeries and gives treatment to patients who have hip and knee problems, such as infection, stiffness, and fractures. Dr. Chen obtained her undergraduate degree in Molecular, Cellular, and Developmental Biology from Yale University in New Haven, CT, and her medical degree from Rutgers Medical School, where she graduated with Distinction in Research and was admitted into the Alpha Omega Alpha Medical Honor Society. During her medical studies, Dr. Chen also earned an MBA from Rutgers Business School and is a member of the Beta Gamma Sigma Honor Society. She then completed her orthopaedic surgery residency at the University of Pittsburgh, followed by a fellowship in hip and knee replacement at the Rothman Institute in Philadelphia. Dr. Chen is an orthopaedic surgeon in active practice, as well as a committed researcher and clinician-scientist. Dr. Chen is a recognized and sought-after leader in her profession, both nationally and internationally. She also actively collaborates with fundamental scientists exploring these challenging scientific challenges in laboratories around Harvard Medical School. She is the Appropriate Use Criteria Leader for the American Academy of Orthopaedic Surgeons (AAOS) Evidence-Based Quality and Value Committee and recently served as President of the Musculoskeletal Infection Society (MSIS). Goal of episode: To develop a baseline knowledge on KA w/ Extensor Mechanism Failure . We cover: Extensor Mechanism Rupture Patellar fracture Quad tendon rupture Patella tendon rupture Allograft extensor reconstruction Post-op protocol Complications
Drs Sheean and Gomoll discuss Safety and Efficacy of an Amniotic Suspension Allograft Injection over 12 Months in a Single-Blinded, Randomized Controlled Trial for Symptomatic Osteoarthritis of the Knee
Drs Nuelle and Smith discuss Superior Capsular Reconstruction Using Dermal Allograft Is a Safe and Effective Treatment for Massive Irreparable Rotator Cuff Tears: 2-Year Clinical Outcomes
Click here to read the article.
Author William Bugbee discusses "Revision Osteochondral Allograft Transplantations: Do They Work?" from the November 2013 issue of AJSM. Click here to read the article.
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