The Lake Erie College of Osteopathic Medicine (LECOM) is a private medical school in Erie, Pennsylvania, Greensburg, Pennsylvania, Bradenton, Florida, DeFuniak Springs, Florida and Elmira, New York. Founded in 1992, LECOM confers medical (D.O.), dental (DMD), pharmacy (PharmD), as well as master's degrees in the health sciences. LECOM operates one of the few accelerated three-year pharmacy programs in the country, and is one of 2 pharmacy schools in the country with a distance education program.With over 2,200 enrolled medical students, the College of Osteopathic Medicine at LECOM is the largest medical school in the United States.LECOM is accredited by the Middle States Commission on Higher Education, the American Osteopathic Association's Commission on Osteopathic College Accreditation, the Commission on Dental Accreditation, and the Accreditation Council for Pharmacy Education.
Background: Extended platelet-rich fibrin (e-PRF) membranes are a novel 100% autologous biomaterial with a longer resorption time (4-6 months) than traditional solid-PRF membranes (two weeks). In part 1 of this 2-part publication series, four clinical variations for using these novel e-PRF membranes for socket preservation were introduced. In this randomized clinical trial (RCT), all four iterations of e-PRF membranes were compared to traditional collagen membranes in alveolar ridge preservation for hard and soft tissue dimensional changes and early wound healing outcomes. Methods: A single-center RCT was conducted, including 55 patients requiring the extraction of a single tooth with planned implant placement. All sockets were grafted with a "sticky bone" (bone allograft mixed with PRF) and secured with either a collagen membrane (control) or e-PRF membranes utilizing the four variations present in Part 1 (both formed extra-orally or intra-orally, each with or without an overlying solid PRF membrane). The time of fabrication and application of each e-PRF iteration was recorded. Cone beam computed tomography was utilized to evaluate horizontal and vertical ridge dimensions at baseline and 3 months post-operatively, and soft tissue thickness was also measured at both time intervals utilizing an endodontic reamer. Early wound healing was recorded at 2 weeks, utilizing the Landry, Turnbull, and Howley Index by three blinded clinicians. Results: The results demonstrated that, at 3 months, the e-PRF membranes fabricated utilizing all 4 treatment variations demonstrated equal improvements in horizontal and vertical ridge dimensions and soft tissue thickness when compared to collagen membranes. Additionally, the membrane (p = 0.029) and membrane w/solid (p = 0.021) groups demonstrated statistically significant superior early wound healing compared to the collagen membrane group. Notably, the Bio-Filler groups demonstrated statistically significant reduction in fabrication/application time compared to the membrane groups. Conclusions: Within the limitations of this RCT, all e-PRF iterations performed comparably to collagen membranes in maintaining both hard and soft tissue ridge dimensions when combined with sticky bone, while also significantly improving soft tissue wound healing. Future RCTs with alternative grafting materials, direct wound-margin assessment, and evaluation of patient-reported outcomes are necessary to clarify the advantages of each membrane type.
The older adult population is rising, resulting in a larger number of adults residing in nursing homes. Skin cancer is most commonly diagnosed in older adults. Yet, these individuals often face limited access to advanced dermatologic care, in addition to unique risk factors such as inadequate sun protection and reduced mobility. This review aims to map the current evidence on skin cancer risk and diagnosis, as well as prevention strategies among older adults residing in nursing homes. A search was conducted on PubMed using the algorithm: ((nursing home) OR (assisted living) OR (elderly living facility)) AND (skin cancer), where 269 papers were retrieved. Inclusion criteria included full-text primary sources published from 2015 to 2025. Exclusion criteria included duplicates, reviews, animal studies, and studies not about skin cancer in nursing home settings. Title review narrowed the search to 38 papers. Following abstract screening, five final papers were included. A comprehensive review of the included studies demonstrated that there is a high prevalence of skin cancer among nursing home residents. There were a total of 4785 participants among the five papers, and skin cancer prevalence varied from 15 to 40% across studies. Nearly half of the diagnosed cases were basal cell carcinoma, a quarter were squamous cell carcinoma, and the final quarter was unspecified. Factors that contribute to the prevalence of skin cancer include age, immobility, incontinence, and a lack of appropriate sun protection. Additionally, systematic barriers, such as limited access to specialized dermatologic services, the absence of standardized screening practices, and limited staff training, increase the risk of delayed diagnosis and inadequate management of skin cancer in nursing home patients. Skin cancer in older adults, particularly those in long-term care, is also shaped by psychosocial challenges such as personality traits that influence distress, reduced quality of life, and delays in seeking treatment, highlighting the importance of early detection and supportive care interventions. To improve outcomes for this vulnerable population, there is a need to implement routine skin assessments, strengthen staff education on dermatologic care, and increase timely specialist referrals for proper detection and treatment of skin cancer.
Fungating breast tumors represent advanced breast cancer and are frequently complicated by secondary infection. While bacterial colonization is common, infection with carbapenem-resistant Pseudomonas aeruginosa (CR-PSA) in breast wounds is rare and poses significant therapeutic challenges. We report the case of a 60-year-old woman who presented with a six-month history of a progressively enlarging fungating right breast mass, with delayed evaluation due to severe blood-injection-injury (BII) phobia. On admission, she was septic and profoundly anemic. Imaging demonstrated a large exophytic breast mass with bilateral axillary lymphadenopathy, and biopsy confirmed grade 3 invasive mammary carcinoma. Wound cultures grew CR-PSA, necessitating intravenous antibiotics, surgical debridement, and targeted antimicrobial therapy. Her clinical course required blood transfusions and multiple specialities consulted prior to stabilization and discharge for outpatient oncologic care. This case highlights the potential for fungating breast tumors to harbor multidrug-resistant organisms and illustrates how psychological barriers to care can contribute to advanced disease and complex clinical presentations.
Background Chronic diseases remain a predominant cause of mortality worldwide despite existing therapies, which often have side effects and high costs. Natural compounds, such as kavain from Piper methysticum, have attracted attention for their therapeutic potential and safety, showing diverse biological activities useful in treating various health conditions. Purpose This study aimed to assess the potential role of kavain in the prevention and treatment of chronic diseases, with a particular focus on its anti-inflammatory, anxiolytic, antithrombotic, neuroprotective, and anticancer properties. Method A comprehensive literature search on kavain was conducted using PubMed, Scopus, Science direct and Web of Science databases, considering both preclinical and clinical studies. The term “kavain” was used, and all titles, abstracts, and keywords were screened for relevant information. Results Findings from various experimental models suggest that kavain exhibits significant biological and pharmacological activities across various pathological conditions, including inflammation, anxiety, neurological disorders, cardiovascular diseases, and cancer. Pharmacokinetic studies reveal its rapid absorption, moderate oral bioavailability, and efficient systemic clearance. Mechanistically, kavain regulates various molecular pathways including nuclear factor-κB and mitogen-activated protein kinase signaling, modulation of γ-aminobutyric acid type A receptor activity, and inhibition of osteoclastogenesis. Toxicity studies indicate that kavain is well-tolerated at physiologically relevant concentrations. Clinical reports show its anxiolytic potential with favorable safety profile. Conclusion Kavain has demonstrated considerable therapeutic potential in the prevention and management of various chronic diseases, with relatively few adverse effects. Consequently, further clinical investigations will be beneficial to validate its efficacy and safety in human populations.
Zone II flexor tendon injuries remain among the most challenging conditions in hand surgery due to the region's complex anatomy and high rates of postoperative complications, particularly adhesion formation and the resulting loss of range of motion. Although platelet-rich plasma (PRP), mesenchymal stromal cell (MSC) therapies, and hyaluronic acid (HA) have demonstrated therapeutic potential in other musculoskeletal conditions, their effectiveness in preventing postoperative adhesions following zone II flexor tendon repair, specifically, remains unclear. A comprehensive review of the literature was conducted using PubMed and Google Scholar to identify randomized controlled trials, prospective and retrospective cohort studies, and original research evaluating the use of PRP, MSCs, or HA in zone II flexor tendon repair. Only full-length English-language studies specifically addressing zone II injuries were included. Studies were excluded if they did not focus explicitly on zone II flexor tendon injuries, lacked clearly reported outcomes, or failed to assess postoperative adhesion formation and functional recovery. Search terms included but were not limited to "Zone II flexor tendon," "PRP Zone II flexor tendon repair," "stem cell Zone II flexor tendon repair," "hyaluronic acid Zone II flexor tendon repair." Data from both human and animal studies were collected to compare postoperative adhesion formation and functional outcomes. Studies across all compounds showed inconsistent results in animal and human trials. PRP for zone II flexor tendon repair showed limited and inconsistent benefits, with most preclinical and clinical trials reporting no significant improvement in adhesion prevention or range of motion. Higher leukocyte concentrations in PRP were associated with increased inflammatory activity, potentially promoting scar formation. In contrast, mesenchymal stromal cell therapies, particularly adipose- and synovium-derived MSCs, demonstrated promising preclinical effects by modulating inflammation, reducing scar-related gene expression, limiting apoptosis, and enhancing tendon gliding though statistical significance was not always achieved. HA showed the most promising results with a majority of animal and human studies consistently reducing adhesion formation and improving tendon excursion and functional outcomes in the long-term. Across all the examined studies, no agent- PRP, MSCs, or HA- consistently prevented postoperative adhesions or reliably improved range of motion following zone II flexor tendon repair, specifically. The complex anatomy of zone II, inconsistent functional outcomes, limited mechanistic understanding, and wide methodological variation among studies, continue to limit the ability to draw definitive conclusions. Cost and accessibility further complicate the clinical adoption of these adjuncts. Current evidence does not support the routine use of PRP, MSCs, or HA for preventing postoperative adhesions after zone II flexor tendon repair. Nevertheless, while research on this topic remains limited, a few existing studies have shown promising trends that warrant further investigation. Future research should incorporate age-specific analyses, standardized agent formulations, clearer mechanistic evaluation, and optimized delivery methods to better determine whether these adjuncts can consistently and reliably improve outcomes in this anatomically challenging region.
