Exile Vol. XXXV No. 2

Peter Goes Groovy, by Carolyn Bern (cover) I Hate Poetry by Craig Bagno 1 Truancy by Richard Latimer 2 I ate a Star Last Night by Rory Herbster 3 Delivery by Amy Judge 4 Untitled by Sue McLain 5 Road Signs by Richard Latimer 7-8 Haiku for Me to Possess by Shannon J. Salser 9 Patches by Michael Payne 10 Untitled by Laura Johnson 11 He by Kent Lambert 13 At the Corner Grill by Lynn Pendleton 14-15 Black Licorice by Richard Latimer 16-17 Blue Shirt by Michael Payne 18 ...Loves a Clown by Margaret Dawson 21-24 The Surreal Sonnet by Shannon J. Salser 26 Untitled by Mat Benson 27 Swimming Lessons by Richard Latimer 29 Communion by Amy Judge 30 Beth\u27s Last Funny Joke by Ted Gould 31-35 Hope for a Peaceful Coming Around by Shannon J. Salser 36 Untitled by Laura Johnson 37 A Child\u27s Moment by Peter Witonsky 39 Observation by Rosemary Walsh 40 Untitled by Carolyn Burns 41 To My Sister by Amy B. Judge 43 Ideas In Bloom by Randy Casden 44 Untitled by Deb Tily 45 A Child of Mind by Charles Riedinger 47 Ars Poetica by Rory Herbster 48 Untitled by Mat Benson 49 REPRINTS Dancer by Bradford Cover 52 Skin Deep by Eric Whitney 53-55 Sunset by Chris Rynd 56 Editorial decision is shared equally among the Editorial Board Members -cover page The editors of Exile would like to formally apologize to those contributors whose works were misprinted in the Fall issue. We have reprinted a few of the pieces that contained the most errors. -51 NOTE: An uncredited and untitled piece of artwork appears on page 19. NOTE: Carolyn Bern (cover) Burns (41) and Berns (contributor notes) all appear to refer to the same artist

External Bone Size Is a Key Determinant of Strength‐Decline Trajectories of Aging Male Radii

Given prior work showing associations between remodeling and external bone size, we tested the hypothesis that wide bones would show a greater negative correlation between whole‐bone strength and age compared with narrow bones. Cadaveric male radii (n = 37 pairs, 18 to 89 years old) were evaluated biomechanically, and samples were sorted into narrow and wide subgroups using height‐adjusted robustness (total area/bone length). Strength was 54% greater (p < 0.0001) in wide compared with narrow radii for young adults (<40 years old). However, the greater strength of young‐adult wide radii was not observed for older wide radii, as the wide (R2 = 0.565, p = 0.001), but not narrow (R2 = 0.0004, p = 0.944) subgroup showed a significant negative correlation between strength and age. Significant positive correlations between age and robustness (R2 = 0.269, p = 0.048), cortical area (Ct.Ar; R2 = 0.356, p = 0.019), and the mineral/matrix ratio (MMR; R2 = 0.293, p = 0.037) were observed for narrow, but not wide radii (robustness: R2 = 0.015, p = 0.217; Ct.Ar: R2 = 0.095, p = 0.245; MMR: R2 = 0.086, p = 0.271). Porosity increased with age for the narrow (R2 = 0.556, p = 0.001) and wide (R2 = 0.321, p = 0.022) subgroups. The wide subgroup (p < 0.0001) showed a significantly greater elevation of a new measure called the Cortical Pore Score, which quantifies the cumulative effect of pore size and location, indicating that porosity had a more deleterious effect on strength for wide compared with narrow radii. Thus, the divergent strength–age regressions implied that narrow radii maintained a low strength with aging by increasing external size and mineral content to mechanically offset increases in porosity. In contrast, the significant negative strength–age correlation for wide radii implied that the deleterious effect of greater porosity further from the centroid was not offset by changes in outer bone size or mineral content. Thus, the low strength of elderly male radii arose through different biomechanical mechanisms. Consideration of different strength–age regressions (trajectories) may inform clinical decisions on how best to treat individuals to reduce fracture risk. © 2019 American Society for Bone and Mineral Research.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149566/1/jbmr3661_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149566/2/jbmr3661.pd

State of the mineralized tissue comprising the femoral ACL enthesis in young women with an ACL failure

Despite poor graft integration among some patients that undergo an ACL reconstruction, there has been little consideration of the bone quality into which the ACL femoral tunnel is drilled and the graft is placed. Bone mineral density of the knee decreases following ACL injury. However, trabecular and cortical architecture differences between injured and non-injured femoral ACL entheses have not been reported. We hypothesize that injured femoral ACL entheses will show significantly less cortical and trabecular mass compared to non-injured controls.Femoral ACL enthesis explants from 54 female patients (13 – 25 years) were collected during ACL reconstructive surgery. Control explants (n = 12) were collected from 7 donors (18 - 36 years). Injured (I) femoral explants differed from those of non-injured (NI) controls with significantly less (p ≤ 0.001) cortical volumetric bone mineral density (vBMD) (NI: 736.1 – 867.6 mg/cc; I: 451.2 – 891.9 mg/cc), relative bone volume (BV/TV) (NI: 0.674 – 0.867; I: 0.401 – 0.792) and porosity (Ct.Po) (NI: 0.133 – 0.326; I: 0.209 – 0.600). Injured explants showed significantly lesstrabecular vBMD (p = 0.013) but not trabecular BV/TV (p = 0.314), thickness (p = 0.412), or separation (p = 0.828). We found significantly less cortical bone within injured femoral entheses compared to non-injured controls.Lower cortical and trabecular bone mass within patient femoral ACL entheses may help explain poor ACL graft osseointegration outcomes in the young and may be a contributor to the osteolytic phenomenon that often occurs within the graft tunnel following ACL reconstruction

Associations Among Hip Structure, Bone Mineral Density, and Strength Vary With External Bone Size in White Women

ABSTRACT Bone mineral density (BMD) is heavily relied upon to reflect structural changes affecting hip strength and fracture risk. Strong correlations between BMD and strength are needed to provide confidence that structural changes are reflected in BMD and, in turn, strength. This study investigated how variation in bone structure gives rise to variation in BMD and strength and tested whether these associations differ with external bone size. Cadaveric proximal femurs (n = 30, White women, 36–89+ years) were imaged using nanocomputed tomography (nano‐CT) and loaded in a sideways fall configuration to assess bone strength and brittleness. Bone voxels within the nano‐CT images were projected onto a plane to create pseudo dual‐energy X‐ray absorptiometry (pseudo‐DXA) images consistent with a clinical DXA scan. A validation study using 19 samples confirmed pseudo‐DXA measures correlated significantly with those measured from a commercially available DXA system, including bone mineral content (BMC) (R2 = 0.95), area (R2 = 0.58), and BMD (R2 = 0.92). BMD–strength associations were conducted using multivariate linear regression analyses with the samples divided into narrow and wide groups by pseudo‐DXA area. Nearly 80% of the variation in strength was explained by age, body weight, and pseudo‐DXA BMD for the narrow subgroup. Including additional structural or density distribution information in regression models only modestly improved the correlations. In contrast, age, body weight, and pseudo‐DXA BMD explained only half of the variation in strength for the wide subgroup. Including bone density distribution or structural details did not improve the correlations, but including post‐yield deflection (PYD), a measure of bone material brittleness, did increase the coefficient of determination to more than 70% for the wide subgroup. This outcome suggested material level effects play an important role in the strength of wide femoral necks. Thus, the associations among structure, BMD, and strength differed with external bone size, providing evidence that structure–function relationships may be improved by judiciously sorting study cohorts into subgroups. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research