Cross-Sectional Survey of Relevant Literatures as to the Current Proposed Disease Mechanisms and Treatments of Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic Lateral Sclerosis (ALS), more commonly referred to as Lou Gehrig’s disease, is a progressively degenerative neuromuscular disorder affecting both the upper and lower motor neurons and preferentially affecting males in their forties to seventies. Although the pathology of ALS has been clearly elucidated elsewhere, the precise mechanisms by which the disease progresses and the means by which it is acquired are still poorly understood areas of medicine. Current genomic and proteomic studies in human and animal models have yielded exciting and promising new findings that may help elucidate this pathology. It is the purpose of this review article to discuss the most relevant proposed mechanisms in current medical literature available from NCBI’s PubMed database as well as to highlight past, present, and future pharmacologic intervention therapies which have experienced varying degrees of success. This is by no means an exhaustive assessment of the current literature available, however it should suffice as a thorough review of the most salient points of modern ALS research

Medicine outside the Clinic: The Growing Need for Physicians in Sexual Education Policy

Sex and sexuality are both topics of immense social and personal importance, owing their openness or constraint in large part to the society in which they are discussed. In homogenous groups it may be possible to reach firm consensus on what is, or is not, appropriate to consider a sexual norm and use an overarching set of religious or spiritual morals to reaffirm this decision. However, in western society and specifically in the United States, a theme of integration and amalgamation of wildly different cultures has presented an interesting case study in searching for common ground on basic social issues. Notable amongst these is the question of sexual education and the role of government, religion, and family in determining the way and extent to which information is presented to individuals during their formative years. However, suspiciously absent in these discussions is the role of trained medical practitioners in vetting these curricula and participating in the education process

E-cigarettes: An Up to Date Review and Discussion of the Controversy

Electronic cigarettes (e-cigarettes) present a novel method for nicotine delivery that is reportedly advantageous when compared to traditional cigarette usage. Manufacturers and consumers claim reduced chemical exposure, decreased symptom profiles, and efficacy in smoking reduction and cessation greater than conventional nicotine replacement therapies (NRT). However these products present new challenges and concerns to legislators, clinicians, and public health advocates. Questions of authority in state and federal legislation, establishing product quality control, assessing long-term studies on e-cigarettes and quantifying usefulness in harm reduction represent only a portion of the many unanswered topics being discussed. The purpose of this article is to assess the literature on e-cigarettes and establish perceptions and attitudes on this controversial subject

Traumatic Posterior Tibial Pseudoaneursym: A rare late complication repaired conventionally

Posterior tibial artery pseudoaneurysms are extremely rare. They commonly present as a late complication of trauma or iatrogenic injury. Diagnosis can be elusive. Treatment has been described in the context of open primary repair, endovascular stenting, and coil embolization. There has been increasing interest in the use of endovascular treatment options for this type of injury. If left untreated, pseudoaneurysms can rupture, partially thrombose, expand and cause adjacent local compression and compartment syndrome. The following case presented is of a young gentleman with a posterior tibial pseudoaneurysm incidentally discovered after stepping on glass and the management of his posterior tibial pseudoaneurysm

Traumatic Posterior Tibial Pseudoaneursym: A rare late complication repaired conventionally

Posterior tibial artery pseudoaneurysms are extremely rare. They commonly present as a late complication of trauma or iatrogenic injury. Diagnosis can be elusive. Treatment has been described in the context of open primary repair, endovascular stenting, and coil embolization. There has been increasing interest in the use of endovascular treatment options for this type of injury. If left untreated, pseudoaneurysms can rupture, partially thrombose, expand and cause adjacent local compression and compartment syndrome. The following case presented is of a young gentleman with a posterior tibial pseudoaneurysm incidentally discovered after stepping on glass and the management of his posterior tibial pseudoaneurysm

Orthopaedic Surgeon Density in West Virginia

Abstract West Virginia (WV) has many healthcare disparities and access barriers. For bone and joint disorders, WV has some of the highest rates of musculoskeletal problems, including the highest reported rate of adult arthritis in the nation (36.2%). We hypothesized that WV has one of the lowest Orthopaedic surgeon densities in the country, which can negatively impact the delivery of musculoskeletal care. Using the WV Board of Medicine practitioner databank, the Veterans Administration practitioner data, and national Orthopaedic surgeon census data, we demonstrated a considerably low Orthopaedic surgeon density in WV (7.71/100,000 population versus the national average of 8.51/100,000 population) with 54% of our counties (n=30) having no Orthopaedic surgeons. This data is currently being used to further determine the appropriate allocation of resources to help improve access to specialized orthopaedic care for our state

Scalable Patterning Using Laser-Induced Shock Waves

An advanced direct imprinting method with low cost, quick, and minimal environmental impact to create a thermally controllable surface pattern using the laser pulses is reported. Patterned microindents were generated on Ni50Ti50 shape memory alloys and aluminum using an Nd: YAG laser operating at 1064 nm combined with a suitable transparent overlay, a sacrificial layer of graphite, and copper grid. Laser pulses at different energy densities, which generate pressure pulses up to a few GPa on the surface, were focused through the confinement medium, ablating the copper grid to create plasma and transferring the grid pattern onto the surface. Scanning electron microscope and optical microscope images show that various patterns were obtained on the surface with high fidelity. One-dimensional profile analysis indicates that the depth of the patterned sample initially increases with the laser energy and later levels off. Our simulations of laser irradiation process also confirm that high temperature and high pressure could be generated when the laser energy density of 2  J/cm2 is used

Orthopaedic Surgeon Density in West Virginia

West Virginia (WV) has many healthcare disparities and access barriers. For bone and joint disorders, WV has some of the highest rates of musculoskeletal problems, including the highest reported rate of adult arthritis in the nation (36.2%). We hypothesized that WV has one of the lowest Orthopaedic surgeon densities in the country, which can negatively impact the delivery of musculoskeletal care. Using the WV Board of Medicine practitioner databank, the Veterans Administration practitioner data, and national Orthopaedic surgeon census data, we demonstrated a considerably low Orthopaedic surgeon density in WV (7.71/100,000 population versus the national average of 8.51/100,000 population) with 54% of our counties (n=30) having no Orthopaedic surgeons. This data is currently being used to further determine the appropriate allocation of resources to help improve access to specialized orthopaedic care for our state

The Two Faces of Anomaly Mediation

Anomaly mediation is a ubiquitous source of supersymmetry (SUSY) breaking which appears in almost every theory of supergravity. In this paper, we show that anomaly mediation really consists of two physically distinct phenomena, which we dub "gravitino mediation" and "Kahler mediation". Gravitino mediation arises from minimally uplifting SUSY anti-de Sitter (AdS) space to Minkowski space, generating soft masses proportional to the gravitino mass. Kahler mediation arises when visible sector fields have linear couplings to SUSY breaking in the Kahler potential, generating soft masses proportional to beta function coefficients. In the literature, these two phenomena are lumped together under the name "anomaly mediation", but here we demonstrate that they can be physically disentangled by measuring associated couplings to the goldstino. In particular, we use the example of gaugino soft masses to show that gravitino mediation generates soft masses without corresponding goldstino couplings. This result naively violates the goldstino equivalence theorem but is in fact necessary for supercurrent conservation in AdS space. Since gravitino mediation persists even when the visible sector is sequestered from SUSY breaking, we can use the absence of goldstino couplings as an unambiguous definition of sequestering.Comment: 21 pages, 1 table; v2, references added, extended discussion in introduction and appendix; v3, JHEP versio

Ab-Externo AAV-Mediated Gene Delivery to the Suprachoroidal Space Using a 250 Micron Flexible Microcatheter

The current method of delivering gene replacement to the posterior segment of the eye involves a three-port pars plana vitrectomy followed by injection of the agent through a 37-gauge cannula, which is potentially wrought with retinal complications. In this paper we investigate the safety and efficacy of delivering adeno-associated viral (AAV) vector to the suprachoroidal space using an ab externo approach that utilizes an illuminated microcatheter.6 New Zealand White rabbits and 2 Dutch Belted rabbits were used to evaluate the ab externo delivery method. sc-AAV5-smCBA-hGFP vector was delivered into the suprachoroidal space using an illuminated iTrackTM 250A microcatheter. Six weeks after surgery, the rabbits were sacrificed and their eyes evaluated for AAV transfection using immunofluorescent antibody staining of GFP.Immunostaining of sectioned and whole-mounted eyes demonstrated robust transfection in all treated eyes, with no fluorescence in untreated control eyes. Transfection occurred diffusely and involved both the choroid and the retina. No apparent adverse effects caused by either the viral vector or the procedure itself could be seen either clinically or histologically.The ab externo method of delivery using a microcatheter was successful in safely and effectively delivering a gene therapy agent to the suprachoroidal space. This method presents a less invasive alternative to the current method of virally vectored gene delivery