Report on the Challenges of Air Transportation Experienced by People with Disabilities

Boarding an airplane is difficult for persons with mobility impairments and increases the risk of injury to both passengers and employees. Airplane seats are uncomfortable and lack the necessary support for many individuals with disabilities. Additionally, airplane restrooms can be inaccessible to wheelchair users. Potential solutions for these issues include the use of detachable plane seats or personal wheelchairs on board and an airplane redesign to provide additional restroom space. The number of service and emotional support animals being brought on airplanes have also increased substantially over the past few years. Passengers that travel with their service animals must contend with having to follow different rules for different airlines carriers and not having sufficient space for animals to be safe and comfortable

Sacroplasty for Sacral Insufficiency Fractures: Narrative Literature Review on Patient Selection, Technical Approaches, and Outcomes

Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued. Candidates for sacroplasty are patients with persistent pain, inability to tolerate immobilization, or patients with low bone mineral density. Before undergoing sacroplasty, patients’ bone health should be optimized with pharmacotherapy. Anabolic agents prior to or in conjunction with sacroplasty have been shown to improve patient outcomes. Sacroplasty can be safely performed through a number of techniques: short-axis, long-axis, coaxial, transiliac, interpedicular, and balloon-assisted. The procedure has been demonstrated to rapidly and durably reduce pain and improve mobility, with little risk of complications. This article aims to provide a narrative literature review of sacroplasty including, patient selection and optimization, the various technical approaches, and short and long-term outcomes

Delayed cerebrospinal fluid (CSF) leak following anterior cervical discectomy and fusion surgery

Background: An uncommon complication of anterior cervical discectomy and fusion (ACDF) is dura tear, which may be further complicated by cerebral spinal fluid (CSF) leak. Dural tears with CSF leak can lead to catastrophic neurologic outcomes and should be recognized early. Case Description: This case report describes a 43-year-old female patient with history of Ehlers-Danlos syndrome who presented 1-year post-ACDF with positional headaches and lightheadedness. Imaging revealed ACDF plate subsidence and CSF leak with inferior displacement of the cerebellar tonsils. Outcome: The patient underwent a revision procedure with removal of index screws and CSF repair using epidural blood patch, fat graft, and Tisseel. The original bicortical screws were replaced with shorter larger diameter unicortical screws. Post-operative imaging at 2 and 6 weeks confirmed resolution of CSF leak. Conclusions: Healthcare professionals and patients undergoing spinal surgery should be aware of late presentation CSF leaks which can represent gradual decline in neurological function. Surgical candidates at risk to develop CSF leaks should be counseled about possible complications in preoperative planning

Reduction of adolescent grade IV L5–S1 spondylolisthesis with anterior joystick manipulation during a combined anterior and posterior surgical approach: A case report

ABSTRACT: Background: High-grade isthmic spondylolisthesis poses a clinical challenge in the pediatric and adolescent population. Current surgical management using posterior-based approaches may lead to incomplete reduction and restoration of listhesis, disc height, and lordosis. Combined anterior and posterior approach addresses these issues but has been infrequently reported, mainly in the treatment of low-grade isthmic spondylolisthesis. Neither offers good disc space visualization and control of spinal alignment during reduction. Case Description: A healthy 17-year-old female presented with 9 months of progressively worsening lower back pain radiating down the left lower extremity and 3 inches of height loss. Diagnosis of grade IV L5–S1 spondylolisthesis was made using plain radiographs, CT, and MRI. Management with combined anterior and posterior fusion, involving the manual manipulation of segments using an anterior pedicle screw joystick, was pursued. Outcome: Satisfactory alignment, solid arthrodesis, no complications, and improved patient reported outcomes. Conclusions: Combined anterior and posterior fusion with anterior joystick manipulation allowed for full reduction of grade IV spondylolisthesis and restoration of disc/foraminal height and L5–S1 segmental lordosis without neurological complication. Although less commonly performed in children and adolescents, this surgical approach can assist in restoring optimal alignment in isthmic spondylolisthesis

Myeloma-modified adipocytes exhibit metabolic dysfunction and a senescence-associated secretory phenotype (SASP)

Bone marrow adipocytes (BMAd) have recently been implicated in accelerating bone metastatic cancers such as acute myelogenous leukemia and breast cancer. Importantly, bone marrow adipose tissue (BMAT) expands with aging and obesity - two key risk factors in multiple myeloma disease prevalence - suggesting that BMAd may influence and be influenced by myeloma cells in the marrow. Here we provide evidence that reciprocal interactions and cross-regulation of myeloma cells and BMAd play a role in multiple myeloma pathogenesis and treatment response. Bone marrow biopsies from MM patients revealed significant loss of BMAT with myeloma cell infiltration of the marrow, whereas BMAT was restored after treatment for multiple myeloma. Myeloma cells reduced BMAT in different pre-clinical murine models of multiple myeloma and in vitro using myeloma cell-adipocyte co-cultures. In addition, multiple myeloma cells altered adipocyte gene expression and cytokine secretory profiles, which were also associated with bioenergetic changes and induction of a senescent-like phenotype. In vivo, senescence markers were also increased in the bone marrow of tumor-burdened mice. BMAd, in turn, provided resistance to dexamethasone-induced cell cycle arrest and apoptosis, illuminating a new possible driver of myeloma cell evolution in a drug resistant clone. Our findings reveal that bi-directional interactions between BMAd and myeloma cells have significant implications for the pathogenesis and treatment of multiple myeloma. Targeting senescence in the bone marrow adipocyte or other bone marrow cells may represent a novel therapeutic approach for treatment of multiple myeloma

Development of a core outcome set for basal cell carcinoma

BACKGROUND: There is variation in the outcomes reported in clinical studies of basal cell carcinoma (BCC). This can prevent effective meta-analyses to answer important clinical questions. OBJECTIVE: To identify a recommended minimum set of core outcomes for BCC clinical trials. METHODS: Patient and professional Delphi process to cull a long-list, culminating in a consensus meeting. To be provisionally accepted, outcomes needed to be deemed 'important' (score: 7-9, of maximum of 9) by 70% of each stakeholder group. RESULTS: 235 candidate outcomes identified via a systematic literature review and survey of key stakeholders were reduced to 74 that were rated by 100 health care professionals and patients in two Delphi rounds. 27 outcomes were provisionally accepted. The final core set of 5 agreed-upon outcomes after the consensus meeting was: complete response; persistent or serious adverse events; recurrence-free survival; quality of life; and patient satisfaction, including with cosmetic outcome. LIMITATIONS: English-speaking patients and professionals rated outcomes extracted from English-language studies. CONCLUSIONS: A core outcome set (COS) for basal cell carcinoma has been developed. Use of relevant measures may improve the utility of clinical research and the quality of therapeutic guidance available to clinicians