American Osteopathic Association

Microplastics (<5 mm) are an increasing concern for environmental and human health, continuously detected in ecosystems worldwide and a variety of human tissues. While health effects remain unclear, experimental studies on microplastic particles have suggested adverse outcomes. Microplastic fibers, which shed from everyday items, are more toxic than particles and twice as prevalent, yet remain understudied. Microplastic studies vary widely and use various extraction techniques, with few validating recovery accuracy. These limited recovery studies primarily examine particles, raising concerns about the true abundance of microfibers. This study establishes baseline recovery rates of polyethylene terephthalate (PET) and polypropylene (PP) microfibers of varying lengths from formalin-fixed human cadaveric lung tissue. Following enzymatic and oxidative digestion, PET microfibers showed a recovery rate of 47%, while 87% of PP microfibers was recovered. Chemical alterations were assessed using laser direct infrared (LDIR) spectroscopy; optical microscopy and scanning electron microscopy (SEM) evaluated physical changes post-digestion. These findings provide insights into microfiber recovery, highlight potential over- and underestimations, and characterize the chemical and physical behavior of fibers within human tissue studies. Establishing accurate recovery methods is essential for advancing microfiber toxicology research and assessing potential health risks.

Myofascial force transmission has been proposed as a mechanism by which mechanical stimuli applied to one body region can influence the behavior of distant segments through fascial continuity. The posterior spiral chain (PSC), linking the latissimus dorsi, thoracolumbar fascia, and contralateral gluteal region, has been described anatomically, but its functional relevance in vivo remains incompletely understood.A single-group pre-post experimental study was conducted on 73 healthy participants. Trunk rotation in the transverse plane was assessed using inertial digital goniometry under four conditions: two baseline assessments, isometric activation of the PSC via right hip abduction-external rotation, and post-stretching of the caudal segment of the PSC (right or left side, alternating allocation procedure). Left and right trunk rotation, total rotational range of motion (ROM), and rotational balance were analyzed.Baseline trunk rotation showed no lateral asymmetry and no sex-related differences. Isometric activation of the PSC induced a marked redistribution of trunk rotation, characterized by a significant increase in left rotation and a concomitant reduction in right rotation, with only a small reduction in total ROM. Stretching produced a partial rebalancing of the activation-induced asymmetry. While total ROM did not differ between stretching sides, rotational balance shifted toward the treated side, indicating a direction-specific effect.Modulation of myofascial tension along the posterior spiral chain alters trunk rotational patterns in vivo without increasing overall rotational amplitude. These findings support the functional relevance of the PSC and suggest that myofascial interventions may primarily act by redistributing available motion rather than by increasing total range of motion, with potential implications for the assessment and treatment of rotational dysfunctions.

Therapeutic magnetic fields are widely used in rehabilitation and physiotherapy for musculoskeletal and neurological conditions. However, their use in oncological patients has historically been approached with caution and is often considered contraindicated, despite limited clinical evidence supporting this concern. A systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE was searched for studies evaluating therapeutic magnetic fields in oncological populations. Studies were classified according to predefined research questions addressing oncological safety, supportive care during cancer treatment, and management of comorbidities. Study selection, data extraction, and qualitative synthesis were performed. A total of 3,841 records were identified. Only one randomized controlled trial specifically assessed oncological safety outcomes and found no evidence of disease progression, reduced survival, or impaired treatment response associated with magnetic field exposure. A larger body of heterogeneous evidence evaluated magnetic fields as supportive interventions during oncological treatments, particularly for chemotherapy-induced peripheral neuropathy, quality of life, and symptom burden. These studies reported improvements in neurotoxicity, patient-reported outcomes, and treatment tolerability, although methodological limitations were common. Evidence regarding pain management and rehabilitation in oncological remission was predominantly observational. Current evidence does not support the assumption that therapeutic magnetic fields are inherently harmful in oncological patients. While data on oncological safety remain limited, available studies do not indicate adverse oncological outcomes. Magnetic field therapy may represent a feasible supportive intervention for symptom management and rehabilitation in selected oncological populations. However, well-designed prospective trials are required to better define safety profiles, clinical efficacy, and appropriate indications.

Introduction Pembrolizumab is a monoclonal antibody used to treat various cancers via monotherapy or in conjunction with other chemotherapeutic regimens. Randomized-control trials report adrenal insufficiency in approximately 0.7% of patients on pembr

Virtual reality (VR) is a rapidly growing concept in the field of medical education, offering significant potential for innovation. Assessing how VR is used in ophthalmology to teach medical students, residents, and attendings will help identify areas where VR can be further developed. Moreover, analyzing the strengths and limitations of VR in medical education, surgical training, and patient education within ophthalmology will provide valuable insights into its impact on the field.This scoping review aimed to (1) map the current applications of VR across ophthalmology education, (2) analyze the effectiveness of VR interventions for different learner groups, (3) identify gaps in current VR implementation, and (4) assess the quality of evidence supporting VR use in ophthalmology education.A literature review was performed by scanning databases including PubMed, IEEE Xplore®, and Education Resources Information Center (ERIC). Relevant articles published from 2015 to 2023 were identified through the databases. Inclusion and exclusion criteria were formed for the articles to be further analyzed for eligibility. Articles were further categorized based on their VR application and target learners.Most studies targeted the education of ophthalmology residents, highlighting a gap in VR use among students, other healthcare personnel, and patients. Future research should focus on expanding VR applications to these underrepresented groups. The rapid growth of VR in other areas of medical education suggests similar potential to enhance ophthalmology knowledge and skills across a more comprehensive audience. Research in the application of VR in ophthalmology education should extend beyond surgical training for residents to maximize its potential in improving patient care. For example, studies could explore how VR training improves the ophthalmic diagnostic skills of medical students, evaluate whether VR-based patient education enhances understanding of ophthalmic conditions and leads to improved patient outcomes, and whether VR training for opticians aids in the early detection of specific conditions like diabetic retinopathy. This review is limited by excluding grey literature, which may limit the material analyzed and overlook insights from non-peer-reviewed sources.

The meniscus is a weight-bearing, intra-articular, fibrocartilaginous structure that is frequently injured. Traditional special tests for diagnosis of intra-articular lesions of the knee involve provocative tests with compressive or torsional components, often leading to increased pain. With this case study, we aim to introduce the Tibial Distraction Test (TDT), a novel clinical special test for the assessment of intra-articular knee joint lesions, including meniscus injury and osteoarthritis (OA), without provoking pain. A 30-year-old man presented to the clinic with right knee pain and swelling of two months duration following a forceful extension and internal rotation motion which led to a catch then audible pop and discomfort. The patient's initial assessment included McMurray's test, joint line palpation, and Apley's compression tests with positive results for each test. A second examiner, blinded to the initial examination, assessed the patient using the proposed TDT. The patient reported pain relief, indicating a positive result. Subsequent magnetic resonance imaging (MRI) confirmed the diagnosis of a medial meniscus tear. Arthroscopy showed a full-thickness meniscal tear and debridement was performed. At one month's follow-up, the patient returned to baseline function with resolution of symptoms. Diagnosing intra-articular lesions of the knee requires a thorough history and examination, frequently including painful provocative clinical special tests in a patient already presenting with pain as a primary complaint. Our case presents a novel manual clinical special test in a seated position which appears to be a pain-relieving test that may be used to assess for intra-articular knee joint lesions.

Rasmussen’s Encephalitis is a rare neurological condition causing inflammation of the brain, which thereafter can result in seizures, neuronal death, and significant neurological deficits. Its exact cause is unknown and it typically presents in children. The best known treatment is a surgical hemispherectomy to prevent the spread of inflammation, however this is invasive and not without risk. The best therapeutic approach has been with immunomodulation using the antimetabolite agent, azathioprine. Monoclonal antibodies such as rituximab have shown promise in early clinical trials for the treatment of Rasmussen’s Encephalitis, but little has been done to compare the efficacy of rituximab versus azathioprine. A systematic review was then conducted with a study in which patients were treated with rituximab for Rasmussen’s Encephalitis (RE) compared to a study in which patients were treated with azathioprine. The presence of focal encephalitis characterized by epilepsia partialis continua (EPC) was measured in both studies following the treatments. Azathioprine and Rituximab both had statistically significant effects on decreasing the incidence of epilepsia partialis continua when compared to their respective controls. However, rituximab seemed to have a greater effect on reducing the incidence of EPC than azathioprine. Rituximab seems to have an immense potential in reducing EPC in patients with RE. For this review, Rituximab seemed to have a greater reduction in EPC than azathioprine. Further studies with greater sample sizes assessing reductions in the several other complications of RE must be conducted in order to confirm whether or not Rituximab is truly a better choice than Azathioprine.

Jacobs syndrome and congenital adrenal hyperplasia are separate entities but share common clinical features such as ambiguous genitalia. Further studies are needed to conclude the relationship between Jacobs syndrome and congenital adrenal hyperplasia. A 5-month-old male infant was evaluated for ambiguous genitalia. Examination revealed cryptorchidism, inguinal hernia, long phallus, and Grade 3 scrotal hypospadias. Serum 17-OH progesterone was high and chromosomal analysis showed 47XYY/45XO. A diagnosis of Jacobs and CAH was made. The parents were counseled about the patient's condition. He was given hydrocortisone and referred to the pediatric surgeon for further management.