Browsing by Author "Tran, Apollo"
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Item Association between GDF5 single nucleotide polymorphism rs143383 and chronic lower back pain(2019-03-05) Phillips, Nicole R.; Aryal, Subhash; Licciardone, John C.; Tran, ApolloIntroduction. Low back pain presents a unique and ongoing challenge for patients and physicians. Of those who experience an episode of low back pain, 10% go on to develop persistent chronic low back pain (CLBP). However, the cause of this progression is not understood and it is unclear why the clinical manifestation of CLBP differs across individuals. There is a large body of evidence demonstrating the role of genetics as a risk factor CLBP. Growth factor differentiation factor 5 (GDF5) is a protein involved in the growth and development of bone and cartilage. A variant of GDF5, single-nucleotide polymorphism (SNP) rs143383 has been implicated with increased susceptibility and severity of musculoskeletal disorders such as osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. Considering that the cause of low back pain often involves musculoskeletal pathology, rs143383 may be implicated with symptomatology and the progression to persistent CLBP. Objective. This study seeks to determine whether the rs143383 SNP is associated with pain severity in CLBP. We hypothesize that subjects with the CC genotype experience higher levels of pain compared to the TT and CT genotypes. Methods. This project is an observational cohort study based on data retrieved from The Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION). Subjects were divided into three groups, TT, CT, and CC. Average pain levels based on the Numerical Rating Scale (NRS) for low back pain were compared among the groups. Results. Using a general linear model, we found that the rs143383 SNP was significantly associated with NRS scores (P = 0.001). We also found that the CC genotype had a statistical higher mean NRS score than the CT (P = 0.0370) and TT (P = 0.0004) genotypes. However, when the data was adjusted for race, ethnicity, gender and age, no significance was found between rs143383 and NRS scores. Conclusion. Our findings indicate that there is no association between the GDF5 rs143383 polymorphism after adjusting for race and ethnicity. We were unable to complete a stratified analysis due to the distribution of participants in each strata. Larger studies should consider a stratified analysis to determine whether there is an association between rs143383 and CLBP within different ethnicities and racial groups.Item Biomechanic Comparison of Reconstruction Techniques for AC joint Dislocation(2021) Tran, Apollo; Bibb, PatrickBackground: Acromioclavicular (AC) joint disruption comprises 8% of all shoulder injuries. There is still broad debate on when treatment with surgery is indicated and what surgery technique will provide optimal results. Purpose: In this study, we propose a modified technique that we hypothesize will provide the most security to a Rockwood type III AC joint dislocation with the least amount of post-operative complications. Materials and Methods: A rig to mount the cadaver specimens was constructed using a steel rails, screws, and L-brackets and fastened securely to the MTS apparatus. A total of 20 cadaveric shoulders will be gathered and each randomly assigned to one of three groups: 1) reconstruction with graft loop with fibertape augmentation and 2) reconstruction loop using two fibertapes and 3) reconstruction with the Mazzocca technique. The AC and CC ligaments will be released to simulate a Rockwood type III injury and reconstructed using one of the techniques listed above. The reconstructed specimen will then undergo load to failure (120 mm/min) in the superior direction to evaluate maximal loading capacity of the repair construct. Discussion: Difference compared to native for vertical migration of the AC joint, load to failure and mode of failure of the technique will be analyzed for variance if statistical significance is found (P< 0.05) followed by a Bonferroni post hoc analysis. With trials still underway, we anticipate the AC joint repair with augmented graft loop will decrease vertical migration and increase strength compared to previously described techniques.Item Biomechanic Evaluation of AC Joint Reconstruction Techniques: A Systematic Review(2019-03-05) Mong, Joy; Wagner, Lianne; Schultz, Matthew; Hoelscher, Skyler MD; Webb, Brian MD; Tran, ApolloBackground. Acromioclavicular (AC) joint disruption comprises 3.2% of all shoulder injuries, yet there is still broad debate on the optimal surgical approach. Over 150 surgical variations have been proposed, however the lack of common terminology and experimental standards make it challenging to draw any conclusions. For such predicaments, systematic reviews that provide a methodical approach for navigating the literature and have proven useful for identifying areas for improvement, standardizing protocols, and providing direction for a comprehensive analysis. Objective. The purpose of this review is to: 1) systematically evaluate the current state of the literature concerning the biomechanical testing of AC reconstruction; 2) to summarize the surgical techniques and testing procedures; and 3) to identify biomechanical areas that are not well represented in the existing literature. Methods. We completed a literature search to identify biomechanical studies on AC joint fixation using Medline, Scopus, and Excerpta Medica Database (EMBASE) following the 2009 PRISMA statement. Articles were independently reviewed by two investigators and any disagreements were reconciled by consensus in consultation with a third investigator. Investigators independently abstracted data from each study, focusing on surgical techniques and characteristics of the testing protocol. Results. The most popular techniques were the Modified Weaver Dunn and suture button techniques with a tunnel through or looping under the coracoid. To assess construct performance, 28 out of 39 studies included a load to failure protocol to evaluate strength and stiffness of the construct. 18 studies measured vertical plane translation, 16 studies measured horizontal motion, and 5 studies measured rotation. Conclusion. Overall, the most common techniques involved graft with suture augmentation. Techniques looping under the coracoid decreased the likelihood of fracture whereas techniques going through the coracoid improved stability and better maintained reduction. Free graft and hookplates have been found to be biomechanically or clinically inferior. Elastic stiffness serves as a reliable indicator for quantifying early construct stability while strength and translation better represent long-term functional stability. While general conclusions can be made from current biomechanic literature, a more objective verdict requires better standardization of terminology and testing procedures.Item Current research status on the treatment of veisalgia using Silybum marianum(2019-03-05) Powell, Jake; Nguyen, Thuy; Tran, ApolloBackground. There is abundant anecdotal evidence for products claiming to reduce veisalgia after alcohol consumption. Among these products is milk thistle (Silybum marianum), a plant that has been widely touted for its hepatoprotective properties against toxins such as alcohol, venom and plant poisons. Companies commonly promote the use of milk thistle proactively and/or actively as a treatment to attenuate symptoms of veisalgia. However, none of these claims are substantiated by research. Purpose. The purpose of this study is to evaluate the current state of the literature concerning the use of milk thistle for treating veisalgia. The supplement is commercially promoted as a cure for hangovers and we aim to assess the validity of these claims. Methods. We completed a literature search on milk thistle and veisalgia using Medline, Scopus, and Excerpta Medica Database (EMBASE). Because there are currently no studies directly linking milk thistle with hangovers, we identified the main pathophysiological pathways implicated with veisalgia to cross examine the validity of using milk thistle for treatment. Results. No studies directly examined the treatment of veisalgia with milk thistle. However, several studies demonstrated milk thistle to have antioxidant and antitoxin effects in the liver, small intestine, and stomach. Animal studies have found that milk thistle may contribute to hepatocyte regeneration and reduce inflammatory processes. Multiple clinical trials using milk thistle as treatment for a variety of liver diseases suggest that milk thistle may be a viable and biologically active supplement. However, most clinical trials assessed milk thistle’s effects on liver related diseases such as hepatitis. Conclusions. Veisalgia is a multifactorial pathological state that has been implicated with liver damage and inflammation. Milk thistle has been found to provide benefits for a variety of liver diseases, which share several pathophysiological processes that cause veisalgia. Based on this evidence it is possible that milk thistle could be effective in alleviating veisalgia symptoms in common with liver disease. However, there is not enough evidence in the current literature to definitively indicate milk thistle for the treatment of veisalgia.Item Kinematic Analysis of Sagittal Plane Stability of Delta Frame External Fixation(2018-03-14) Beck, Cameron; Tran, Apollo; Hoy, Austin; Barcak, Eric; Wood, AddisonPurpose: External fixation with a delta frame construct is the most common construct used for temporizing patient distal tibia and ankle injuries. While these constructs may be the most common there are numerous variations that are often performed based on surgeon preference. The inclusion or exclusion of a posterior slab or 1st metatarsal pin to the construct is variable amongst surgeons and have little data to support their use aside from anecdotal evidence. Methods: 10 Fresh Frozen Cadavers were secured to a custom-made rig that held the tibia rigid and allowed the application of a standard delta frame external fixator. The specimens had a 2 cm segment of bone resected near the ankle plafond to simulate a highly unstable distal tibia or pilon fracture. The ankle was then loaded with a 10 lb weight from the great toe and 3D kinematics were recorded using an electromagnetic tracking system with 6 degrees of freedom. The 4 construct comparisons were: 1. Delta frame 2. Delta frame with 1st metatarsal pin 3. Delta frame with posterior slab 4. Delta frame with 1st metatarsal pin and posterior slab Results: The delta frame construct without any additions was less stable than all other constructs with statistical significance in the sagittal plane with regards to flexion/extension rotation. The most stable construct was a delta frame with 1st metatarsal pin and posterior slab. The most cost-effective measure to add sagittal plane stability was the addition of the posterior slab splint. Conclusion: Delta frame stability in the sagittal plane can be cost effectively augmented by the addition of a posterior slab. The addition of both a posterior slab or 1st metatarsal pin were able to significantly add stability to the base construct and the combination of the 2 were able to achieve highest stability.Item Single stage bilateral flexible intramedullary fixation of periprosthetic distal femur fractures(2020) Wagner, Russell; Sambhariya, Varun; Rahman, Shawn; Neal, David; Tran, ApolloWe present a patient with bilateral Rorabeck II/Su III periprosthetic distal femur fractures treated successfully with bilateral single stage flexible intramedullary fixation. Flexible intramedullary fixation of Rorabeck II/Su III periprosthetic distal femur fractures provides the benefits of shorter operative time, lower blood loss, and preservation of bone stock compared to plate fixation and distal femur replacement. We suggest that for patients with similar injuries flexible intramedullary fixation can be a viable treatment option.Item Single-stage bilateral distal femur replacement for traumatic distal femur fractures(2019-03-05) Sambhariya, Varun MD; Tran, Apollo; Rahman, Shawn; Dean, Thad DO; Wagner, Russell MD; Sanchez, Hugo MD, PhD; Neal, David MDBackground. Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures remains a difficult challenge for orthopedic surgeons. Previous case series have shown distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and provide stability. However, bilateral injury treated with single stage DFR is rarely encountered and to our knowledge, there are no case reports in the literature. We present a patient with traumatic open left Su III/Rorabeck III periprosthetic distal femur fracture and closed right comminuted intraarticular distal femur fracture with end-stage arthrosis treated with bilateral DFR. We suggest that in elderly patients with similar injuries bilateral DFR can be a viable treatment option. Case Information. An 80-year-old female with past surgical history of left TKA in 2005 presented to our hospital after being involved in a motor vehicle collision resulting in open left periprosthetic distal femur fracture and a closed comminuted right intraarticular distal femur fracture with end-stage arthrosis. She also had a history of anemia and end-stage right knee arthritis for which she was planning a TKA in 2017. She was admitted by our geriatric trauma service for medical optimization prior to surgery. The on-call operative team planned open reduction internal fixation of the open left periprosthetic distal femur fracture after obtaining XR and CT. After making a lateral approach to the femur her fracture was found to be more comminuted than anticipated and the bone-prosthesis interface was not intact. An intraoperative decision was made to place an external fixator with referral to the arthroplasty service for evaluation for possible DFR. For the right distal femur fracture, closed reduction was performed with placement of a knee immobilizer. The patient was taken to the operating room on the 7th day post-admission for bilateral DFR. Postoperatively the patient was made weight bearing as tolerated to both lower extremities and worked with physical therapy daily. She is driving, maintaining her home, and living independently. On exam, her surgical incisions are well healed without evidence of infection. Knee range of motion is from 0-110 degrees bilaterally. One-year postoperative radiographs were obtained demonstrating unchanged alignment of her previously placed prostheses with no signs of loosening Conclusion. Bilateral DFR is a viable treatment option for Su III periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis. We suggest that in elderly patients with similar injuries, bilateral DFR can effectively compensate for bone loss, relieve knee pain, provide stability, and allow for earlier mobilization resulting in satisfactory patient outcomes.Item Surgical Treatment of Acromioclavicular Dislocations: A Scoping Review(2021) Tran, Apollo; Beal, Jennifer; Powell, JakeBackground. While AC joint dislocation accounts for 3.2% of all shoulder injuries, there is still debate on the optimal surgical approach. Over 150 surgical variations have been proposed for AC joint reconstruction. The literature for reconstruction varies widely by technique and focus of analysis, focusing on either clinical or biomechanical studies. Objective. This study aims to clarify research on the most commonly conducted AC joint reconstruction procedures by combining clinical and biomechanical studies into an organized review. In addition, we will identify new procedure designs and evaluate them for possible application in future reconstructive surgeries. Methods.We will complete a literature review to identify biomechanical studies on AC joint fixation using Medline, Scopus, and Excerpta Medica Database (EMBASE) following the 2009 PRISMA statement. Articles will be independently reviewed by at minimum two investigators and any disagreements will be reconciled by consensus in consultation with a third investigator. Results. Analysis of the most commonly performed procedures combines the biomechanical and clinical research associated with each technique. Results are categorized into ligament reconstruction and fixation. Ligament reconstruction pertains to the techniques of Modified Weaver-Dunn, autograft, and allograft. Fixation techniques will include Hook plate, Coracoclavicular Screw Fixation (Bosworth), Cortical Flip Button (endobutton), and K wire fixation. Conclusion. Past reviews focused solely on clinical or biomechanical aspects of AC joint reconstruction, rarely combining the two fields of study. Our review aims to join the different modes of study to provide a clearer picture of technique outcomes.Item The role of acute heating in modulating the pressor response to hypoxic stress(2020) Romero, Steven; Smith, Michael; Stedke, Alexandra; Moore, Amy; Hemmingway, Holden; Tran, ApolloRepetitive airway obstruction accompanying Obstructive Sleep Apnea (OSA) produces hypoxic stress, which increases sympathetic nerve activity (SNA) and mean arterial pressure (MAP). Acute hot water immersion offers protective benefits by increasing blood flow while decreasing arterial pressure; while this effect has been repeatedly demonstrated, the effect of thermal stress on the vascular response to hypoxic apnea has not been examined. This project investigates whether acute heating alters the cardiovascular responses to acute hypoxic stress. Subjects wear a heated suit to increase their core body temperature; breath-holds are then performed at three different increments, as the subject's temperature increases (~0.4°C, ~0.8°C and ~1.2°C above baseline). After 60 min of heating, a recovery period begins, and subjects repeat the hypoxic breath-holds as temperature decreases by ~0.4°C, ~0.8°C and ~1.2°C. Measurements of arm blood flow, brachial artery blood pressure, HR, ABP, and SpO2 are monitored throughout the experiment. The data is currently being evaluated: outcome variables will be analyzed using a hypoxia condition-time mixed model, and planned comparisons will be used to examine specific group-time interactions based on hypoxia level and time pre and post heating. Our findings may represent a form of physiologic cross-tolerance that could be a model for potential therapeutic intervention in conditions such as OSA. This will enhance the basic understanding of the physiology of these two stress conditions and provide preliminary insights into the possible use of heat conditioning as therapy for conditions related to vascular dysregulation.