Does Chiropractic Care Benefit Low Back Pain? Interview with:
“Back Pain” by betterhealthosteopathy is licensed under PDM 3.0Christine Goertz DC, PhD

Vice Chancellor for Research and Health Policy
Palmer College of Chiropractic What is the background for this study?

Response: Low back pain in the leading cause of physical disability worldwide, with up to 80% of US adults seeking care for this debilitating condition at some point in their lives. Low-back pain is also one of the most common causes of disability in U.S. military personnel.

Although a number of studies have previously evaluated chiropractic care for low back pain, the vast majority had small sample sizes and did not study chiropractic as part of a multi-disciplinary approach to care in real world settings, including the military.

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Drug Holidays From Osteoporosis Meds Linked to More Broken Bones Interview with:
“Just a hairline fracture...” by Gloria Bell is licensed under CC BY 2.0Brittany Bindon, MD

Department of Internal Medicine
University of Chicago
Chicago, Illinois What is the background for this study?

Response: Bisphosphonates are commonly used in the treatment of osteoporosis, however, they have been associated with rare, severe side effects such as osteonecrosis of the jaw and atypical femoral fractures.

As a result, bisphosphonate drug holidays have become common in clinical practice though currently, there are minimal data on the safe duration of these drug holidays. We sought to further characterize the clinical and laboratory parameters associated with increased fracture risk in patients on bisphosphonate drug holiday.

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Sciatica: Biomarker Demonstrates Inflammation, Not Just Compression of Nerve Roots Interview with:

“osteopathic treatment for sciatica” by betterhealthosteopathy is licensed under PDM 3.0Daniel Albrecht, PhD
Research Fellow in Radiology, Harvard Medical School
Research Fellow, Massachusetts General Hospital What is the background for this study? What are the main findings?

Response: A great deal of preclinical work in animal models of pain has established that activation of peripheral immune cells or, in the central nervous system (brain and spinal cord), immune cells called “glia” (microglia and astrocytes) play a key role in the establishment and/or maintenance of persistent pain. For instance, if you pharmacologically block activation of these cells in the nervous system, you are able to reduce/inhibit/prevent pain behaviors, e.g. in animals who have received a nerve injury.

This observation is very exciting, because it suggests that blocking neuroinflammation may be a viable way of treating pain. However, the evidence linking human chronic pain with neuroinflammation has so far been limited.

In this study we show, for the first time, that patients with chronic sciatica (that is, back pain that shoots down the leg) demonstrate elevations in the levels of a protein called the translocator protein (TSPO) in the spinal cord and in the nerve roots.

Because TSPO is a marker of neuroinflammation, our results suggest that sciatica is associated with neuroinflammation.

While on average patients do show elevations in the levels of the TSPO, we also saw significant variability across individuals. Importantly, patients that show stronger elevations (in the nerve roots) were those who benefit the most from receiving a local anti-inflammatory treatment (epidural spinal injection). This makes sense: patients whose nerve roots are inflamed benefit from an anti-inflammatory treatment. Those whose nerve roots aren’t inflamed, don’t receive the same benefit. In the latter case, the source of the inflammation and pain may not be the nerve roots, but may be the spinal cord, or, as we showed in a previous paper (Loggia et al., Brain 2015), the brain.  Continue reading

Osteoporosis Drug Has Potential To Fight Triple Negative Breast Cancer Interview with:
Chenfang Dong, Ph.D & M.D.
Department of Pathology and Pathophysiology
Zhejiang University School of Medicine, What is the background for this study? What are the main findings? 

Response: Basal-like breast cancer (BLBC), which generally falls into the triple-negative breast cancer subtype, is associated with a poor clinical outcome due to few treatment options and poor therapeutic response; thus there is a pressing need to elucidate the determinants of aggressiveness in BLBC and identify potential therapeutic targets for this challenging disease.

By analyzing gene expression profiles of breast cancer in multiple publicly available datasets that contain over 5000 cases, we have identified that UDP-galactose ceramide galactosyltransferase (UGT8), a key enzyme in the sulfatide biosynthetic pathway, promotes BLBC progression by activating sulfatide-αVβ5 axis.

Importantly, we identify that zoledronic acid (ZA), a marketed drug for treating osteoporosis and bone metastasis, is a direct inhibitor of UGT8, which has the potential to become a valuable targeted drug for treating Basal-like breast cancer.  Continue reading

Which NSAID for Knee Pain Works Best? Interview with:
“dog” by Neil Mullins is licensed under CC BY 2.0Deborah S. Cummins, PhD

Director, Research, Quality and Scientific Affairs
American Academy of Orthopaedic Surgeons
On behalf of the researchers:
David Jevsevar, MD, MBA; Gregory A. Brown, MD, PHD, and Deborah S. Cummins, PhD What is the background for this study? What are the main findings?

Response: It is estimated that individuals have a 45% risk of developing knee osteoarthritis (OA) in their lifetime. As a result of the shifting demographics of the US, where an increasing percentage of the population is older than 65, the burden of knee OA will continue to increase. To help deal with this burden, effective nonsurgical treatments are needed to manage knee OA symptoms associated with pain and function before surgical intervention becomes necessary. To determine which non-surgical options are best, we performed a network meta-analysis exploring mixed treatment comparisons for nonsurgical treatment of knee osteoarthritis in order to effectively rank the various nonsurgical treatment options from best to worst.

Our network meta-analysis suggests that the single most effective nonsurgical treatment for improving knee function is function is naproxen, followed by diclofenac, celecoxib, and ibuprofen. When considering pain and function together, our data suggest that naproxen is the most effective treatment followed by IA corticosteroid injection.

The single most effective short-term (4-6 weeks) treatment for decreasing pain is intra-articular (IA) corticosteroid injection, followed by ibuprofen, IA platelet rich plasma, and naproxen. Additionally, intra-articular hyaluronic acid injections never achieved a rank in the top five treatments for pain, function, or combined pain and function. An analysis of 12 articles also found that HA is not significantly different than IA placebo in effect.

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Every Pitch Should Count Interview with:
“Pitching Crop” by slgckgc is licensed under CC BY 2.0Jason L. Zaremski, MD, CAQSM, FACSM, FAAPMR

Assistant Professor│Divisions of PM&R, Sports Medicine, & Research
Department of Orthopaedics and Rehabilitation
Co-Medical Director Adolescent & High School Outreach Program
University of Florida College of Medicine What is the background for this study? What are the main findings?

Response: Throwing injuries are common in baseball and can be caused by excessive pitch counts, year-round pitching, and pitching with arm pain and fatigue. Despite the evidence, pitching injuries among high school players have not decreased. With a multitude of research in overhead throwers, yet the volume of overuse throwing injuries not decreasing, our team suspected there was a missing workload factor in baseball pitchers. Therefore, our team conducted research to determine whether an important factor was being overlooked: volume of pitches thrown during warm-up between innings and bullpen activity in high school varsity baseball pitchers.

In the study, our team counted all pitches thrown off a mound during varsity high school baseball games played by 34 different high schools in North Central Florida during the 2017 season. After counting nearly 14,000 pitches in 115 pitch outings, our team found that 42% of the pitches thrown off a mound were not accounted for in the pitch counts, and that there is a large variability of bullpen pitches being thrown from pitcher to pitcher. Even with a greater focus on pitch counts as a way to prevent injuries, a substantial number of pitches are going unaccounted for in high school players as part of warm-up and bullpen activity.

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How a PET Can Save Your Heart Interview with:


Dr. Taylor

Robert Taylor, MD, PhD
Marcus Chair in Vascular Medicine
Executive Vice Chair, Medicine
Director, Division of Cardiology
Professor of Medicine and
Biomedical Engineering
Emory University School of Medicine What is the background for this study? What are the main findings?

Response: The early identification and localization of bacterial infections is a critical step for initiating effective treatment.   This is particularly challenging in the setting of infections associated with implanted medical devices.  We have developed a highly specific probe for bacteria that is based on the fact that bacteria have a specific system for taking up maltodextrins which are polysaccharides that mammalian cells cannot take up directly.  We can label this probe with either a fluorescent of radioactive tag that allows visualization of the bacteria.

In the current article, we have used an animal model of implantable cardiac devices to demonstrate that our probe is very specific and sensitive for detecting bacterial infections.  It is worth noting that these are subclinical infections that could not be detected by any other means except for surgical removal.

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One or Two Surgeries To Treat an Infected Hip Joint? Interview with:

“Check out this sweet artificial hip! (no I don't need one...)” by dennis crowley is licensed under CC BY 2.0

An example of one type of an artificial hip

Dr Setor Kunutsor PhD
Research Fellow
Musculoskeletal Research Unit
Bristol Medical School What is the background for this study?

Response: Hip replacement is a very common operation that is effective at providing pain relief and improving mobility. Infection is a fortunately infrequent but devastating complication that can occur following joint replacement.

Currently, two main types of surgical procedures are used in treating these infections – one-stage and two-stage revision strategies. In the two-stage procedure, the existing artificial joint is removed in one operation and the patient is treated for several months with antibiotics. A new joint is then inserted in a second operation. In the one-stage procedure, the artificial joint is removed along with all infected tissue and a new one inserted in the same operation. The two-stage procedure has been in use for decades and was regarded as the most effective treatment. There has been an increase in the use of the one-stage procedure as it has also been claimed to be very effective at treating infection. There has been a lot of controversy among orthopaedic surgeons as to which is the best way to treat infected hip replacements. Several studies have been conducted on the topic, but the findings have been inconsistent. Some claim the two-stage to be more effective and others claim the one-stage procedure is. Currently the majority of studies claim the two-stage is better; but no study has been conducted that compares these procedures head-to-head to decide if one is better or if they achieve the same results. Due to the lack of evidence, some surgeons are reluctant to use the one-stage strategy. There was therefore a need to compare the effectiveness of the two surgical strategies using an appropriate study design.

We conducted a study which involved collecting and bringing all previous data together under one umbrella. The process is known as “Individual Participant Data meta-analysis”. It involved communicating with surgeons in different countries all over the world and inviting them to contribute data. We called the name of the group “The Global Infection Orthopaedic Management (INFORM) Collaboration”.

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Ankle Fracture: Close Casting Can Be Alternative To Surgery For Older Patients Interview with:
David Keene DPhil
NIHR Postdoctoral Research Fellow
NDORMS Research Fellow in Trauma Rehabilitation
Critical Care, Trauma and Rehabilitation Trials Group
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
University of Oxford What is the background for this study? What are the main findings? 

Response: Our clinical trial comparing close contact casting to the usual internal fixation surgery for unstable ankle fractures in older adults found that ankle function at six months was equivalent. There was more abnormal healing of the fracture seen on radiographs (malunion) in the casting group (15 percent, compared to 3 percent for surgery) so we aimed to investigate the ankle function outcomes in the longer term. We found that equivalence in ankle function between initial close contact casting and surgery was maintained at three years. What should readers take away from your report?

Response: Our findings indicate that close contact casting is an appropriate alternative treatment to surgery for older people with an unstable ankle fracture. These longer-term outcomes will help surgeons and patients to make informed decisions about the right course of action for them. What recommendations do you have for future research as a result of this work?

Response: Future research will explore if there are certain types of older patients that do well after close contact casting or surgery. Is there anything else you would like to add?

Response: It is worth highlighting that the initial close contact casting was applied in the operating room under anesthesia.

There were no conflicts of interest. 


Keene DJ, Lamb SE, Mistry D, et al. Three-Year Follow-up of a Trial of Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults. JAMA. 2018;319(12):1274–1276. doi:10.1001/jama.2018.0811


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Patient Migration Makes it Difficult To Track Revisions After Total Joint Replacement Interview with:
Terence J. Gioe, MD
American Joint Replacement Registry, Rosemont, IL
UCSF School of Medicine,
San Francisco VA Health Care System What is the background for this study? What are the main findings? 

Response: Hospital-based or regional registries are typically limited in their catchment area, making loss to follow-up a major concern when patients move out of the area or otherwise receive subsequent medical care outside of the original hospital network. The American Joint Replacement Registry (AJRR), a part of the American Academy of Orthopaedic Surgeons’ (AAOS) registries portfolio, has the goal of tracking total joint arthroplasty (TJA) patients nationally across the US, but currently captures only approximately 28% of annual TJA procedures. Until a nationwide network of reporting hospitals is established that covers at least 90% of all TJA procedures, loss to follow-up due to migration will be a key potential limitation of large-scale studies on implant performance in the US.

Assessment of loss to follow-up can provide an essential understanding of the migration patterns of TJA patients, and help to improve recruitment and enrollment efforts of the AJRR. The magnitude and characteristics of patient migration following TJA have not previously been studied in the US.  Continue reading