As the weather gets warmer, people often get motivated to spend more time outdoors. Whether it's working on projects around the house, playing with the grandkids at the park or out exercising, it's important that baby boomers remember their bodies are not as young as they used to be and not overdo it.
In 2007, more than 149,000 people between the ages of 45 and 64 were treated in emergency rooms, clinics and doctors' offices for injuries related to exercise and exercise equipment, according to the U.S. Consumer Products Safety Commission.
"When you are 50, you may injure your body more easily than when you were 20," says James Keeney, MD, an orthopaedic surgeon and member of the American Academy of Orthopaedic Surgeons (AAOS) Leadership Fellows Program. "Joints, tissues and muscles may not be as flexible as they used to be. So as you get older, you need to take extra steps to protect yourself from injuries when you exercise."
The AAOS offers the following tips to help boomers prevent exercise-related injuries:
-- Check with your doctor before beginning any exercise program. A physician will make sure your heart is in good condition and can make recommendations based on your current fitness level. This is especially important if you've had a previous injury.
-- Always warm up and stretch before exercising. Cold muscles are more likely to get injured, so warm up with some light exercise for at least three to five minutes.
-- Avoid being a "weekend warrior." Moderate exercise every day is healthier and less likely to result in injury than heavy activity only on weekends.
-- Don't be afraid to take lessons. An instructor can help ensure you're using the proper form, which can prevent overuse injuries such as tendonitis and stress fractures.
-- Develop a balanced fitness program. Incorporate cardio, strength training and flexibility training to get a total body workout and prevent overuse injuries. Also, make sure to introduce new exercises gradually, so you don't take on too much at once.
-- Take calcium and Vitamin D supplements daily.
-- Listen to your body. As you age, you may not be able to do some of the activities that you did years ago. Pay attention to your body's needs and abilities, and modify your workout accordingly.
-- Remember to rest. Schedule regular days off from exercise and rest when tired.
Baby boomers who exercise regularly are less likely to experience depression, weight gain, diabetes, high blood pressure and sleep disturbances, so it's important to incorporate physical activity into your routine at any age.
For more information about baby boomer exercise safety, visit orthoinfo.
American Academy of Orthopaedic Surgeons (AAOS)
6300 N River Rd.
Rosemont, IL 60018
United States
aaos
воскресенье, 31 июля 2011 г.
четверг, 28 июля 2011 г.
Bioactive Cement Scaffold May Improve Bone Grafts
A new technology for implants that may improve construction or repair of bones in the face, skull and jaw, has been developed by researchers from the American Dental Association Foundation (ADAF) and the National Institute of Standards and Technology (NIST).
Described in recent and upcoming journal articles,* the new technology provides a method for making scaffolds for bone tissue. The scaffold is seeded with a patient's own cells and is formed with a cement paste made of minerals also found in natural bone. The paste is mixed with beads of a natural polymer (made from seaweed) filled with bone cells. The paste is shaped or injected into a bone cavity and then allowed to harden with the encapsulated cells dispersed throughout the structure. The natural polymer beads gradually dissolve when exposed to the body's fluids, creating a scaffold that is filled by the now released bone cells.
The cement, a calcium phosphate material, is strengthened by adding chitosan, a biopolymer extracted from crustacean shells. The implant is further reinforced to about the same strength as spongy natural bone by covering it with several layers of a biodegradable fiber mesh already used in clinical practice.
"Bone cells are very smart," says Hockin Xu, of the ADAF and principal investigator for the project. "They can tell the difference between materials that are bioactive compared to bioinert polymers. Our material is designed to be similar to mineral in bone so that cells readily attach to the scaffold." The researchers used mouse bone cells in their experiments, but in practice surgeons would use cells cultured from patient samples. In addition to creating pores in the hardened cement, the natural polymer beads protect the cells during the 30 minutes required for the cement to harden. Future experiments will develop methods for improving the material's mechanical properties by using smaller encapsulating beads that biodegrade at a predictable rate.
NIST and the American Dental Association Foundation have conducted cooperative research on dental and medical materials since 1928. ADAF researchers focus on development of new dental materials, while NIST specializes in the development of improved technologies and methods for measuring materials properties.
The research was funded by the National Institute of Dental and Craniofacial Facial Research, NIST and ADAF.
*E.F. Burgera, H.H.K. Xu and M.D. Weir. Injectable and rapid-setting calcium phosphate bone cement with dicalcium phosphate dihydrate. Journal of Biomedical Materials Research B. April 2006.
H.H.K. Xu, M.D. Weir, E.F. Burguera and A.M. Fraser. Injectable and macroporous calcium phosphate cement scaffold. Biomaterials. In press.
M.D. Weir, H.H.K. Xu, and C.G. Simon, Jr. Strong calcium phosphate cement-chitosan-mesh construct containing cell-encapsulating hydrogel beads for bone tissue engineering, Journal of Biomedical Materials Research A. In press.
Contact: Gail Porter
gail.porternist
National Institute of Standards and Technology (NIST)
Described in recent and upcoming journal articles,* the new technology provides a method for making scaffolds for bone tissue. The scaffold is seeded with a patient's own cells and is formed with a cement paste made of minerals also found in natural bone. The paste is mixed with beads of a natural polymer (made from seaweed) filled with bone cells. The paste is shaped or injected into a bone cavity and then allowed to harden with the encapsulated cells dispersed throughout the structure. The natural polymer beads gradually dissolve when exposed to the body's fluids, creating a scaffold that is filled by the now released bone cells.
The cement, a calcium phosphate material, is strengthened by adding chitosan, a biopolymer extracted from crustacean shells. The implant is further reinforced to about the same strength as spongy natural bone by covering it with several layers of a biodegradable fiber mesh already used in clinical practice.
"Bone cells are very smart," says Hockin Xu, of the ADAF and principal investigator for the project. "They can tell the difference between materials that are bioactive compared to bioinert polymers. Our material is designed to be similar to mineral in bone so that cells readily attach to the scaffold." The researchers used mouse bone cells in their experiments, but in practice surgeons would use cells cultured from patient samples. In addition to creating pores in the hardened cement, the natural polymer beads protect the cells during the 30 minutes required for the cement to harden. Future experiments will develop methods for improving the material's mechanical properties by using smaller encapsulating beads that biodegrade at a predictable rate.
NIST and the American Dental Association Foundation have conducted cooperative research on dental and medical materials since 1928. ADAF researchers focus on development of new dental materials, while NIST specializes in the development of improved technologies and methods for measuring materials properties.
The research was funded by the National Institute of Dental and Craniofacial Facial Research, NIST and ADAF.
*E.F. Burgera, H.H.K. Xu and M.D. Weir. Injectable and rapid-setting calcium phosphate bone cement with dicalcium phosphate dihydrate. Journal of Biomedical Materials Research B. April 2006.
H.H.K. Xu, M.D. Weir, E.F. Burguera and A.M. Fraser. Injectable and macroporous calcium phosphate cement scaffold. Biomaterials. In press.
M.D. Weir, H.H.K. Xu, and C.G. Simon, Jr. Strong calcium phosphate cement-chitosan-mesh construct containing cell-encapsulating hydrogel beads for bone tissue engineering, Journal of Biomedical Materials Research A. In press.
Contact: Gail Porter
gail.porternist
National Institute of Standards and Technology (NIST)
понедельник, 25 июля 2011 г.
Common Hip Disorder Can Cause Sports Hernia
Sports hernias are commonly found in individuals with a mechanical disorder of the hip and can be resolved with surgery to fix the hip disorder alone in some cases, according to a recent study. The research, conducted by investigators at Hospital for Special Surgery, will be presented at the American Orthopedic Society for Sports Medicine 2011 Specialty Day meeting, held Feb. 19 in San Diego following the annual meeting of the American Academy of Orthopaedic Surgeons.
"If individuals have symptoms of athletic pubalgia otherwise known as sports hernia, doctors should carefully assess their hip joint to make sure there is not an underlying mechanical problem in the hip that may be the bigger problem in the overall function of the athlete," said Bryan Kelly, M.D., co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery who led the study. "If patients present with both sports hernia and femoro-acetabular impingement symptoms, you have to consider what the order of treatment should be or whether you should just treat one." He said the research suggests that treating the joint mechanics first is optimal and if problems persist, doctors can then try surgery for the sports hernia.
In recent years, a hip condition known as femoro-acetabular impingement (FAI) or hip impingement has become widely recognized in the medical community. The hip is a ball-and-socket joint where the upper end of the thigh bone fits into the cup-shaped socket of the pelvis. In a healthy hip joint, the ball rotates freely in the cup, but in some people a bony bump on the upper thigh bone produces a situation where there is inadequate space for the hip bone to move freely in the socket. The result is damage to the socket rim and the cartilage that lines the bones, which can lead to hip arthritis. In the past few years, doctors have thought that this condition may also cause sports hernias. A sports hernia is a tearing of the tissue that forms the inner part of the abdominal wall and inserts into the pubic bone.
To investigate how often FAI is associated with sports hernia, researchers examined the records of all professional athletes who underwent arthroscopic surgery at HSS for symptomatic FAI between April 2005 and April 2010. Patients were included if their FAI limited their ability to return to competitive play. The group, 38 in total, included nine baseball players, 13 football players, eight hockey players, five soccer players, two basketball players, and one skater. Retrospective data regarding prior athletic sports hernia surgery, ability to return to play, and duration until return to play was collected from all patients.
The investigators found that while 32 percent of the athletes had previously undergone surgery for their hernia, none of them had been able to return to their previous level of competition with the hernia surgery alone. One patient underwent hernia surgery at the same time as the FAI surgery. Thirty-nine percent of patients had hernia symptoms that resolved with FAI surgery alone and 36 of 38 patients were able to return to their previous level of play. All 12 patients that had both hernia and FAI surgery were able to return to professional competition. On average, athletes were able to return to their sport 5.9 months after arthroscopic surgery.
This is the first paper that has looked at the coincidence of FAI and sports hernia, and has practical implications for practice. "Groin pulls and lower abdominal muscle strains are frequently associated with hip joint mechanical problems, and patients should make sure that doctors are looking at both those locations as potential sources of the pain," said Dr. Kelly, who is also in the Sports Medicine and Shoulder Service at HSS. "Before this study we knew that both impingement in the hip joint and athletic pubalgia were the cause of decreased function and pain in athletes. Now we recognize that there is a close relationship between those two, and oftentimes the problems coexist and need to be looked at when treatment options are being discussed."
Other Hospital for Special Surgery investigators involved in the study include Asheesh Bedi, M.D., former resident who is now at the University of Michigan Medical Center; Sommer Hammoud, M.D.; Erin Magennis, B.A.; William Meyers, M.D., Drexel University College of Medicine; and Bryan Kelly, M.D.
A High Incidence of Athletic Pubalgia in Professional Athletes with Symptomatic FAI. AOSSM Specialty Day
Saturday, Feb. 19, 8:30 a.m. - 8:37 a.m. San Diego Convention Center, Ballroom 20A.
Source: Hospital for Special Surgery
"If individuals have symptoms of athletic pubalgia otherwise known as sports hernia, doctors should carefully assess their hip joint to make sure there is not an underlying mechanical problem in the hip that may be the bigger problem in the overall function of the athlete," said Bryan Kelly, M.D., co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery who led the study. "If patients present with both sports hernia and femoro-acetabular impingement symptoms, you have to consider what the order of treatment should be or whether you should just treat one." He said the research suggests that treating the joint mechanics first is optimal and if problems persist, doctors can then try surgery for the sports hernia.
In recent years, a hip condition known as femoro-acetabular impingement (FAI) or hip impingement has become widely recognized in the medical community. The hip is a ball-and-socket joint where the upper end of the thigh bone fits into the cup-shaped socket of the pelvis. In a healthy hip joint, the ball rotates freely in the cup, but in some people a bony bump on the upper thigh bone produces a situation where there is inadequate space for the hip bone to move freely in the socket. The result is damage to the socket rim and the cartilage that lines the bones, which can lead to hip arthritis. In the past few years, doctors have thought that this condition may also cause sports hernias. A sports hernia is a tearing of the tissue that forms the inner part of the abdominal wall and inserts into the pubic bone.
To investigate how often FAI is associated with sports hernia, researchers examined the records of all professional athletes who underwent arthroscopic surgery at HSS for symptomatic FAI between April 2005 and April 2010. Patients were included if their FAI limited their ability to return to competitive play. The group, 38 in total, included nine baseball players, 13 football players, eight hockey players, five soccer players, two basketball players, and one skater. Retrospective data regarding prior athletic sports hernia surgery, ability to return to play, and duration until return to play was collected from all patients.
The investigators found that while 32 percent of the athletes had previously undergone surgery for their hernia, none of them had been able to return to their previous level of competition with the hernia surgery alone. One patient underwent hernia surgery at the same time as the FAI surgery. Thirty-nine percent of patients had hernia symptoms that resolved with FAI surgery alone and 36 of 38 patients were able to return to their previous level of play. All 12 patients that had both hernia and FAI surgery were able to return to professional competition. On average, athletes were able to return to their sport 5.9 months after arthroscopic surgery.
This is the first paper that has looked at the coincidence of FAI and sports hernia, and has practical implications for practice. "Groin pulls and lower abdominal muscle strains are frequently associated with hip joint mechanical problems, and patients should make sure that doctors are looking at both those locations as potential sources of the pain," said Dr. Kelly, who is also in the Sports Medicine and Shoulder Service at HSS. "Before this study we knew that both impingement in the hip joint and athletic pubalgia were the cause of decreased function and pain in athletes. Now we recognize that there is a close relationship between those two, and oftentimes the problems coexist and need to be looked at when treatment options are being discussed."
Other Hospital for Special Surgery investigators involved in the study include Asheesh Bedi, M.D., former resident who is now at the University of Michigan Medical Center; Sommer Hammoud, M.D.; Erin Magennis, B.A.; William Meyers, M.D., Drexel University College of Medicine; and Bryan Kelly, M.D.
A High Incidence of Athletic Pubalgia in Professional Athletes with Symptomatic FAI. AOSSM Specialty Day
Saturday, Feb. 19, 8:30 a.m. - 8:37 a.m. San Diego Convention Center, Ballroom 20A.
Source: Hospital for Special Surgery
пятница, 22 июля 2011 г.
Spotlight Put On Osteoporosis Research
McMaster University has teamed up with Eli Lilly Canada and the Canadian Institutes for Health Research (CIHR) to put a world-class researcher on the track of the silent thief.
Osteoporosis, the debilitating disease of bone deterioration, has been called the "silent thief" as it occurs without symptoms.
Today the university announced a $2 million endowed chair has been established to investigate the best strategy for osteoporosis care, particularly for fall and fracture prevention, and to train the next generation of physician scientists to look for a cure.
Dr. Alexandra Papaioannou, a geriatrician and specialist in osteoporosis, has been named the inaugural holder of the endowed Eli Lilly Canada Chair in Osteoporosis. This position has been endowed by $1 million in research funds from Eli Lilly Canada Inc. along with matching funds from the Division of Rheumatology of the Department of Medicine, Michael G. DeGroote School of Medicine.
At the same time, it was announced Dr. Papaioannou also holds a five-year career award, the CIHR/ Eli Lilly Canada Research Chair in Osteoporosis, Falls and Fracture Prevention sponsored by the CIHR/Canada's Research-Based Pharmaceutical Companies (Rx&D) research chair program. This position will enhance the work of the endowed chair. CIHR is the federal agency sponsoring peer-reviewed health research in Canada. Rx&D is the national associationof Canada's research-based pharmaceutical companies. The CIHR/Rx&D career award is valued at $400,000 over five years.
"With this announcement we are taking a leap forward in our journey of discovery in this disabling condition," said Peter George, President and Vice-Chancellor of McMaster University. "McMaster is proud to create this position in partnership with visionaries who also focus on innovation, and Dr. Papaioannou is a McMaster alumna with world class expertise."
Dr. Loren Grossman, Vice-President, Research and Development of Eli Lilly Canada said: "We are proud to support research excellence in osteoporosis in partnership with CIHR and Rx&D. The Chair in osteoporosis is part of Lilly's commitment to develop answers to meet unmet medical needs. It is our hope that this research will help those living with this debilitating and life restricting disease."
"Our support for Dr. Papaioannou is a great example of our strategy of funding the best minds of Canadian research," observed Dr. Alain Beaudet, President of the Canadian Institutes of Health Research. "Her research into better ways to prevent and treat osteoporosis and bone fractures from falls offers great promise and I am sure that she will contribute significantly to the growing body of knowledge and expertise in this field, both in Canada and internationally."
"The CIHR-Rx&D Collaborative Research Program has invested $360 million since 2000 in research institutions across the country to improve the health and prosperity of all Canadians," said Russell Williams, President of Canada's Research-Based Pharmaceutical Companies. "We take great pride in the fact that our community is partnering with CIHR and McMaster to support talented researchers in their exhaustive efforts to find new ways to prevent and treat devastating diseases like osteoporosis."
Osteoporosis leads to increased bone fragility and risk of fracture, and can cause chronic reduction of mobility and decreased independence. It is estimated to impact 1.4 million Canadians, including one in four women and one in eight men over 50.
The cost of treating osteoporosis and osteoporosis-related fractures is estimated to be $1.9 billion each year in Canada alone, including long term, hospital and chronic care.
Source
McMaster University
Osteoporosis, the debilitating disease of bone deterioration, has been called the "silent thief" as it occurs without symptoms.
Today the university announced a $2 million endowed chair has been established to investigate the best strategy for osteoporosis care, particularly for fall and fracture prevention, and to train the next generation of physician scientists to look for a cure.
Dr. Alexandra Papaioannou, a geriatrician and specialist in osteoporosis, has been named the inaugural holder of the endowed Eli Lilly Canada Chair in Osteoporosis. This position has been endowed by $1 million in research funds from Eli Lilly Canada Inc. along with matching funds from the Division of Rheumatology of the Department of Medicine, Michael G. DeGroote School of Medicine.
At the same time, it was announced Dr. Papaioannou also holds a five-year career award, the CIHR/ Eli Lilly Canada Research Chair in Osteoporosis, Falls and Fracture Prevention sponsored by the CIHR/Canada's Research-Based Pharmaceutical Companies (Rx&D) research chair program. This position will enhance the work of the endowed chair. CIHR is the federal agency sponsoring peer-reviewed health research in Canada. Rx&D is the national associationof Canada's research-based pharmaceutical companies. The CIHR/Rx&D career award is valued at $400,000 over five years.
"With this announcement we are taking a leap forward in our journey of discovery in this disabling condition," said Peter George, President and Vice-Chancellor of McMaster University. "McMaster is proud to create this position in partnership with visionaries who also focus on innovation, and Dr. Papaioannou is a McMaster alumna with world class expertise."
Dr. Loren Grossman, Vice-President, Research and Development of Eli Lilly Canada said: "We are proud to support research excellence in osteoporosis in partnership with CIHR and Rx&D. The Chair in osteoporosis is part of Lilly's commitment to develop answers to meet unmet medical needs. It is our hope that this research will help those living with this debilitating and life restricting disease."
"Our support for Dr. Papaioannou is a great example of our strategy of funding the best minds of Canadian research," observed Dr. Alain Beaudet, President of the Canadian Institutes of Health Research. "Her research into better ways to prevent and treat osteoporosis and bone fractures from falls offers great promise and I am sure that she will contribute significantly to the growing body of knowledge and expertise in this field, both in Canada and internationally."
"The CIHR-Rx&D Collaborative Research Program has invested $360 million since 2000 in research institutions across the country to improve the health and prosperity of all Canadians," said Russell Williams, President of Canada's Research-Based Pharmaceutical Companies. "We take great pride in the fact that our community is partnering with CIHR and McMaster to support talented researchers in their exhaustive efforts to find new ways to prevent and treat devastating diseases like osteoporosis."
Osteoporosis leads to increased bone fragility and risk of fracture, and can cause chronic reduction of mobility and decreased independence. It is estimated to impact 1.4 million Canadians, including one in four women and one in eight men over 50.
The cost of treating osteoporosis and osteoporosis-related fractures is estimated to be $1.9 billion each year in Canada alone, including long term, hospital and chronic care.
Source
McMaster University
вторник, 19 июля 2011 г.
LSI Chief Spine Surgeon Dr. James St. Louis Named 2008 Physician Of The Year
Chief spine surgeon Dr. James St. Louis of the Laser Spine Institute in Tampa, Florida was named 2008 Physician of the Year for orthopedic surgery by the American Association of Physician Specialists. He received this award after a committee of orthopedic surgeons evaluated his significant contribution to his specialty.
Dr. St. Louis was honored as 2008 Physician of the Year during the President's Dinner of the House of Delegates and Annual Scientific Meeting held at the Crowne Plaza Resort in Hilton Head, South Carolina in June. Dr. St. Louis was selected to receive this prestigious award by the American Association of Physician Specialists, Inc. (AAPS) in the spring. In addition to 2008, the association selected Dr. St. Louis as a recipient of this prominent award in 2005. Having the honor to receive this award twice is not only extraordinary, but also unlikely.
As the founder of Laser Spine Institute (LSI), Dr. St. Louis has instituted a highly selective and comprehensive minimally invasive approach to spine surgery. LSI offers an outpatient surgical solution for patients suffering from problematical spine conditions. The results are minimal down time and the ability to resume activities and normal lifestyle with significantly less complications.
Dr. St. Louis has treated hundreds of patients from around the globe and, as news of his success spreads, thousands of people worldwide will have the opportunity to find the relief they deserve at LSI in Tampa, FL or Scottsdale, AZ. According to a member of the board of governors, "He has taken spine surgery to a new level and is at least five years ahead of those in the field."
Dr. St. Louis has demonstrated a true commitment to excellence in his profession as an orthopedic surgeon and as a mentor and trainer to others who wish to join him as an expert in minimally invasive spine procedures. As LSI Chief Executive Officer Bill Horne reflects, "Being a former patient of Dr. St. Louis myself, I owe him all of the gratitude for giving me my life back and making me pain free. As his business partner, I share the pleasure of showcasing his talents to hundreds of patients every month that are suffering from similar back and neck pain. On behalf of the Laser Spine Institute, I am honored to announce that Dr. James St. Louis has been recognized as the 2008 Physician of the Year by the American Association of Physician Specialists."
About Laser Spine Institute: Laser Spine Institute offers a successful alternative to traditional open back and neck surgeries. The orthopedic surgeons at LSI can correct painful ailments with endoscopic outpatient procedures. Chronic pain that stems from pinched nerves, herniated discs, bulging discs, degenerative disc disease, spinal stenosis, foraminal stenosis, spinal arthritis, bone spurs, scar tissue and failed open back or neck surgery can be alleviated with Laser Spine Institute's minimally invasive approach.
Potential candidates with back and neck pain can visit laserspineinstitute or call toll free 1-866-853-6191 for more information on outpatient, minimally invasive spine surgery and upcoming seminars in cities across the United States.
The American Association of Physician Specialists, Inc. is a nationally renowned non-profit medical association that helps to monitor the highest professional standards among physician members.
American Association of Physician Specialists, Inc
Dr. St. Louis was honored as 2008 Physician of the Year during the President's Dinner of the House of Delegates and Annual Scientific Meeting held at the Crowne Plaza Resort in Hilton Head, South Carolina in June. Dr. St. Louis was selected to receive this prestigious award by the American Association of Physician Specialists, Inc. (AAPS) in the spring. In addition to 2008, the association selected Dr. St. Louis as a recipient of this prominent award in 2005. Having the honor to receive this award twice is not only extraordinary, but also unlikely.
As the founder of Laser Spine Institute (LSI), Dr. St. Louis has instituted a highly selective and comprehensive minimally invasive approach to spine surgery. LSI offers an outpatient surgical solution for patients suffering from problematical spine conditions. The results are minimal down time and the ability to resume activities and normal lifestyle with significantly less complications.
Dr. St. Louis has treated hundreds of patients from around the globe and, as news of his success spreads, thousands of people worldwide will have the opportunity to find the relief they deserve at LSI in Tampa, FL or Scottsdale, AZ. According to a member of the board of governors, "He has taken spine surgery to a new level and is at least five years ahead of those in the field."
Dr. St. Louis has demonstrated a true commitment to excellence in his profession as an orthopedic surgeon and as a mentor and trainer to others who wish to join him as an expert in minimally invasive spine procedures. As LSI Chief Executive Officer Bill Horne reflects, "Being a former patient of Dr. St. Louis myself, I owe him all of the gratitude for giving me my life back and making me pain free. As his business partner, I share the pleasure of showcasing his talents to hundreds of patients every month that are suffering from similar back and neck pain. On behalf of the Laser Spine Institute, I am honored to announce that Dr. James St. Louis has been recognized as the 2008 Physician of the Year by the American Association of Physician Specialists."
About Laser Spine Institute: Laser Spine Institute offers a successful alternative to traditional open back and neck surgeries. The orthopedic surgeons at LSI can correct painful ailments with endoscopic outpatient procedures. Chronic pain that stems from pinched nerves, herniated discs, bulging discs, degenerative disc disease, spinal stenosis, foraminal stenosis, spinal arthritis, bone spurs, scar tissue and failed open back or neck surgery can be alleviated with Laser Spine Institute's minimally invasive approach.
Potential candidates with back and neck pain can visit laserspineinstitute or call toll free 1-866-853-6191 for more information on outpatient, minimally invasive spine surgery and upcoming seminars in cities across the United States.
The American Association of Physician Specialists, Inc. is a nationally renowned non-profit medical association that helps to monitor the highest professional standards among physician members.
American Association of Physician Specialists, Inc
суббота, 16 июля 2011 г.
Orthopedic Surgeons Debate Whether Knee Implant Designed For Women Is Better Than Standard Implant
Many orthopedic surgeons are debating whether Warsaw, Ind.-based Zimmer Holdings' knee implant Gender Solutions, which is designed specifically for women, is better for women than the standard artificial knee, Reuters reports. According to the Reuters, companies are marketing to women because they currently receive about 60% of knee implants and are expected to fuel the implant business because women live longer and are more likely to be overweight or obese than men. Kalamazoo, Mich.-based Stryker in 2005 introduced a knee implant, called Triathlon, designed for women and small men, and Arlington, Texas-based Wright Medical Technology has submitted an application to FDA for approval of an implant based on a person's size. According to Zimmer, Gender Solutions, which was introduced last year, is smaller and shaped more like a woman's knee, so it fits and functions better than standard implants. Many orthopedic surgeons say that the product, which is about twice the cost of standard implants, is a "marketing gimmick" but that they will use it if a patient requests it, according to Reuters. Raymond Elliott, Zimmer chair and CEO, said that Gender Solutions has been more successful than the company anticipated when it was released last year and that the product's success has contributed to a 23% earnings increase in the fourth quarter of 2006. Zimmer by the end of the year plans to introduce a hip implant designed for women, Reuters reports (Sherman/Dixon, Reuters, 2/15).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
среда, 13 июля 2011 г.
Arthrosurface Performs First Biological Knee Procedure
Arthrosurface, Inc. , the developer of less-invasive joint resurfacing systems, announced that it has performed its first biological knee procedure based on the company's proven HemiCAP® platform technology.
The next generation HemiCAP(BIO) implant is providing a biological scaffold with a cell-friendly surface environment that is supported by a stable, contoured implant.
Arthroscopic cartilage procedures have been targeting bone marrow cells for focal cartilage repair for over two decades. "We are excited to combine our focal HemiCAP® resurfacing technology with the cellular healing response achieved by bone marrow influx," commented Steven Ek, COO.
The technology provides a load sharing matrix that has shown to provide complete biological surface coverage in preclinical tests, said Matthias Schurhoff, MD, VP of Clinical Operations and Scientific Affairs.
Dr. Willem van der Merwe, Sport Science Centre of South Africa, performed the first bio HemiCAP® surgery and has more than five years of experience with the classic HemiCAP® procedure: "I am very satisfied with the follow-up on my previous patients and observed a remarkable return to sports activities. Now, we look forward to assessing the clinical performance criteria for the new bio surface."
The HemiCAP® implant for the femoral condyle is targeting middle aged patients with weight bearing full thickness defects who continue to suffer from knee pain.
Joint preservation is critical for the long term management of knee arthritis. Focal HemiCAP® resurfacing expands reconstructive treatment options intended to delay traditional arthroplasty for patients. In contrast to conventional joint replacement, the company's resurfacing technology allows the surgeon to precisely mill the surface to cover the defect and fit the implant to the patient while preserving healthy cartilage, bone, and soft tissues.
"Arthrosurface continuous to grow its platform to address early and late stage knee arthritis," said Steven Tallarida, President, who observed the first HemiCAP(BIO) implantation.
The system currently offers over 140 different sizes and shapes to effectively treat cartilage defects in a large variety of joints by recreating the patient's joint geometry with an intraoperative 3-D mapping system.
Source: Arthrosurface, Inc
The next generation HemiCAP(BIO) implant is providing a biological scaffold with a cell-friendly surface environment that is supported by a stable, contoured implant.
Arthroscopic cartilage procedures have been targeting bone marrow cells for focal cartilage repair for over two decades. "We are excited to combine our focal HemiCAP® resurfacing technology with the cellular healing response achieved by bone marrow influx," commented Steven Ek, COO.
The technology provides a load sharing matrix that has shown to provide complete biological surface coverage in preclinical tests, said Matthias Schurhoff, MD, VP of Clinical Operations and Scientific Affairs.
Dr. Willem van der Merwe, Sport Science Centre of South Africa, performed the first bio HemiCAP® surgery and has more than five years of experience with the classic HemiCAP® procedure: "I am very satisfied with the follow-up on my previous patients and observed a remarkable return to sports activities. Now, we look forward to assessing the clinical performance criteria for the new bio surface."
The HemiCAP® implant for the femoral condyle is targeting middle aged patients with weight bearing full thickness defects who continue to suffer from knee pain.
Joint preservation is critical for the long term management of knee arthritis. Focal HemiCAP® resurfacing expands reconstructive treatment options intended to delay traditional arthroplasty for patients. In contrast to conventional joint replacement, the company's resurfacing technology allows the surgeon to precisely mill the surface to cover the defect and fit the implant to the patient while preserving healthy cartilage, bone, and soft tissues.
"Arthrosurface continuous to grow its platform to address early and late stage knee arthritis," said Steven Tallarida, President, who observed the first HemiCAP(BIO) implantation.
The system currently offers over 140 different sizes and shapes to effectively treat cartilage defects in a large variety of joints by recreating the patient's joint geometry with an intraoperative 3-D mapping system.
Source: Arthrosurface, Inc
воскресенье, 10 июля 2011 г.
Bone Repair Using Patient's Stem Cells Comes Closer
Hitherto it has been difficult to induce adult human stem cells to produce bone, e.g. in order to repair bone tissue. Researchers at the University of Twente have shown that if the enzyme PKA is previously activated in the stem cells in the lab, following implantation this results in substantial bone formation. This opens up new ways of repairing bone tissue using cell material from the patient. The researchers are publishing their work in the Proceedings of the National Academy of Sciences (PNAS).
In animals, 'adult' mesenchymal stem cells have already been used successfully to grow fresh bone. Bone formation using human adult stem cells, e.g. from bone marrow, has been less successful, which has hitherto limited the alternatives hospitals can offer for repairing damaged tissue other than spontaneous healing. Activating the PKA enzyme prior to implantation, however, produces a dramatic improvement in 'in vivo' bone growth. The cells can be observed maturing into bone cells already in the lab; once sown on a carrier and implanted in a mouse, the bone grows well.
Encouraging the neighbours
The enzyme protein kinase A (PKA) is responsible for many processes in a cell. The messenger 'cyclic AMP' activates PKA: adding it to the stem cells ensures that they stimulate one another, the researchers think. Not only does cyclic AMP promote maturation into bone cells; the cells themselves also secrete various substances that stimulate bone growth. This may explain why mesenchymal stem cells treated with cyclic AMP form significantly more bone than those without the stimulus.
The advantage of administering a bone-growth-stimulating substance in advance is that it can be removed just before implantation. Experiments to date have mainly used high concentrations of a bone-growth-stimulating hormone, e.g. incorporated in the carrier on which the cells are 'sown'. In the new approach not only are the hormone concentrations lower, they also more closely resemble the cocktail of hormones normally involved in bone growth.
This is the second time in a short space of time that the researchers, led by Dr Jan de Boer, have published in PNAS: earlier this month they published an article on a major breakthrough in the use of embryonic stem cells to grow bone. Both methods are promising when it comes to repairing bone tissue in future using cells from the patient's own body. Compact bioreactors will be developed to grow cells quickly into tissue that can be used in the operating theatre.
The research was carried out at the Tissue Regeneration Department of the University of Twente's Institute for Biomechanical Technology (BMTI). The researchers collaborated with fellow scientists at UMC Utrecht and the Erasmus Medical Center in Rotterdam.
TWENTE UNIVERSITY
P.O. Box 217
7500 AE Enschede
utwente.nl
In animals, 'adult' mesenchymal stem cells have already been used successfully to grow fresh bone. Bone formation using human adult stem cells, e.g. from bone marrow, has been less successful, which has hitherto limited the alternatives hospitals can offer for repairing damaged tissue other than spontaneous healing. Activating the PKA enzyme prior to implantation, however, produces a dramatic improvement in 'in vivo' bone growth. The cells can be observed maturing into bone cells already in the lab; once sown on a carrier and implanted in a mouse, the bone grows well.
Encouraging the neighbours
The enzyme protein kinase A (PKA) is responsible for many processes in a cell. The messenger 'cyclic AMP' activates PKA: adding it to the stem cells ensures that they stimulate one another, the researchers think. Not only does cyclic AMP promote maturation into bone cells; the cells themselves also secrete various substances that stimulate bone growth. This may explain why mesenchymal stem cells treated with cyclic AMP form significantly more bone than those without the stimulus.
The advantage of administering a bone-growth-stimulating substance in advance is that it can be removed just before implantation. Experiments to date have mainly used high concentrations of a bone-growth-stimulating hormone, e.g. incorporated in the carrier on which the cells are 'sown'. In the new approach not only are the hormone concentrations lower, they also more closely resemble the cocktail of hormones normally involved in bone growth.
This is the second time in a short space of time that the researchers, led by Dr Jan de Boer, have published in PNAS: earlier this month they published an article on a major breakthrough in the use of embryonic stem cells to grow bone. Both methods are promising when it comes to repairing bone tissue in future using cells from the patient's own body. Compact bioreactors will be developed to grow cells quickly into tissue that can be used in the operating theatre.
The research was carried out at the Tissue Regeneration Department of the University of Twente's Institute for Biomechanical Technology (BMTI). The researchers collaborated with fellow scientists at UMC Utrecht and the Erasmus Medical Center in Rotterdam.
TWENTE UNIVERSITY
P.O. Box 217
7500 AE Enschede
utwente.nl
четверг, 7 июля 2011 г.
Impact Sports Increase Bone Strength In Senior Athletes
Running, basketball and other
high-impact sports may lead to stronger bones as people age, according to a
new study presented today at the 74th Annual Meeting of the American
Academy of Orthopaedic Surgeons. Measurements conducted on senior Olympic
athletes found that the bone mineral density (BMD) for those who
participated in impact sports was significantly greater than athletes who
competed in low-impact sports like swimming and cycling.
"While we know that exercise is vital as we get older, this study finds
that the kind of exercise we choose can be just as important," said Vonda
Wright, MD, lead author and assistant professor in the department of
orthopedic surgery at the University of Pittsburgh Medical Center. "The
findings show that a key to maintaining strong, healthy bones as we age is
to engage in impact sports."
The study evaluated 298 athletes competing in the 2005 Senior Olympic
Games in Pittsburgh. The athletes, ages 50 to 93, completed a
health-history questionnaire and underwent ultrasound to measure BMD. The
BMD T-score for athletes in the high-impact group was .4+/-1.3 versus
-1+/-1.4 for athletes in the non-high impact group. After controlling for
age, sex, obesity and osteoporosis medication, participation in high-impact
sports was found to be a significant predictor of BMD.
"The costs associated with caring for people with osteoporosis and
fractures caused by frail bones are rising as the population ages," Dr.
Wright concluded. "Our study implies that persistent participation in
impact sports can positively influence bone health even in the oldest
athletes."
Osteoporosis is a disease of progressive bone loss affecting 28 million
Americans and contributing to an estimated 1.5 million bone fractures per
year. One in two women and one in five men over age 65 will sustain bone
fractures due to osteoporosis.
American Academy of Orthopaedic Surgeons
aaos/
high-impact sports may lead to stronger bones as people age, according to a
new study presented today at the 74th Annual Meeting of the American
Academy of Orthopaedic Surgeons. Measurements conducted on senior Olympic
athletes found that the bone mineral density (BMD) for those who
participated in impact sports was significantly greater than athletes who
competed in low-impact sports like swimming and cycling.
"While we know that exercise is vital as we get older, this study finds
that the kind of exercise we choose can be just as important," said Vonda
Wright, MD, lead author and assistant professor in the department of
orthopedic surgery at the University of Pittsburgh Medical Center. "The
findings show that a key to maintaining strong, healthy bones as we age is
to engage in impact sports."
The study evaluated 298 athletes competing in the 2005 Senior Olympic
Games in Pittsburgh. The athletes, ages 50 to 93, completed a
health-history questionnaire and underwent ultrasound to measure BMD. The
BMD T-score for athletes in the high-impact group was .4+/-1.3 versus
-1+/-1.4 for athletes in the non-high impact group. After controlling for
age, sex, obesity and osteoporosis medication, participation in high-impact
sports was found to be a significant predictor of BMD.
"The costs associated with caring for people with osteoporosis and
fractures caused by frail bones are rising as the population ages," Dr.
Wright concluded. "Our study implies that persistent participation in
impact sports can positively influence bone health even in the oldest
athletes."
Osteoporosis is a disease of progressive bone loss affecting 28 million
Americans and contributing to an estimated 1.5 million bone fractures per
year. One in two women and one in five men over age 65 will sustain bone
fractures due to osteoporosis.
American Academy of Orthopaedic Surgeons
aaos/
понедельник, 4 июля 2011 г.
Providence Health System Shows Investigational Osteoporosis Therapy Increases Bone Mineral Density
Providence Health System researchers announced today that an investigational therapy for bone loss, denosumab, demonstrated significant increases in bone mineral density (BMD) in postmenopausal women with osteoporosis. Many older adults experience bone loss that leads to low BMD and fractures. Bone mineral density is often used to gauge a person's risk of fracture. These research findings, which were published in the Feb. 23, 2006 issue of The New England Journal of Medicine, are significant especially in light of the recent Surgeon General's report on bone health. The report highlights the need for new, improved approaches to prevention and treatment of osteoporosis and other bone loss conditions.
The article summarizes the results of the phase 2, multi-center trial evaluating the effect of denosumab in postmenopausal women with low BMD. Denosumab is a RANK Ligand inhibitor under development by Amgen, Inc. of Thousand Oaks, Calif. The investigational therapy is designed to target RANK Ligand, a protein that is the primary mediator of osteoclast formation, function and survival. Osteoclasts are the cells responsible for bone removal.
"We are very encouraged by the study's results," said Michael McClung, MD, FACP, principal investigator of the denosumab study and director of Oregon Osteoporosis Center at Providence Portland Medical Center in Portland, Ore. "These data document that targeting the RANK Ligand pathway may provide a new treatment option for bone loss diseases including osteoporosis."
The phase 2 data indicated that denosumab provides rapid and sustained responses of bone metabolism in patients with low BMD. Denosumab, when administered twice yearly, increased total hip, spine, distal 1/3 radius and total body BMD similar to current therapy in the one-year trial. Researchers reported that subcutaneous injections of denosumab significantly increased BMD at the lumbar spine from 3.0 to 6.7 percent after 12 months as compared with a decrease of 0.8 percent with placebo (p
The incidence of adverse events was similar among the denosumab, placebo, and Fosamax groups.
Study Design
Investigators at 29 centers in the United States randomized 412 postmenopausal women, average age 63, with low BMD to receive denosumab, placebo or Fosamax. The purpose of the study was to determine the safety and efficacy of denosumab on lumbar spine BMD compared with placebo at 12 months. The doses of denosumab evaluated included 6, 14 or 30 mg every three months or 14, 60, 100 or 210 mg every six months. Denosumab was administered by subcutaneous injection. Patients receiving Fosamax followed the approved indication and oral dosing instructions of 70 mg once weekly.
About Osteoporosis
In the United States, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis. Of the 10 million Americans estimated to have osteoporosis, eight million are women and two million are men. In addition, one in two women and one in four men over age 50 will have an osteoporosis-related fracture in their remaining lifetime.
About Providence Portland Medical Center
Providence Portland Medical Center is part of Providence Health System, the state's largest health system and second-largest private employer. Providence Portland is recognized for excellence in patient care and research in such areas as cancer, heart, orthopedics, women's health, rehabilitation services and behavioral health. Providence Health System in Oregon, ranked as the fourth most integrated health care system in the nation, offers a comprehensive array of health and education services through its seven hospitals, medical clinics, health plans, long-term care facilities and home health services. Visit providence/oregon.
Contact: Paula Gunness
paula.gunnessprovidence
Porter Novelli /
View drug information on Fosamax.
The article summarizes the results of the phase 2, multi-center trial evaluating the effect of denosumab in postmenopausal women with low BMD. Denosumab is a RANK Ligand inhibitor under development by Amgen, Inc. of Thousand Oaks, Calif. The investigational therapy is designed to target RANK Ligand, a protein that is the primary mediator of osteoclast formation, function and survival. Osteoclasts are the cells responsible for bone removal.
"We are very encouraged by the study's results," said Michael McClung, MD, FACP, principal investigator of the denosumab study and director of Oregon Osteoporosis Center at Providence Portland Medical Center in Portland, Ore. "These data document that targeting the RANK Ligand pathway may provide a new treatment option for bone loss diseases including osteoporosis."
The phase 2 data indicated that denosumab provides rapid and sustained responses of bone metabolism in patients with low BMD. Denosumab, when administered twice yearly, increased total hip, spine, distal 1/3 radius and total body BMD similar to current therapy in the one-year trial. Researchers reported that subcutaneous injections of denosumab significantly increased BMD at the lumbar spine from 3.0 to 6.7 percent after 12 months as compared with a decrease of 0.8 percent with placebo (p
The incidence of adverse events was similar among the denosumab, placebo, and Fosamax groups.
Study Design
Investigators at 29 centers in the United States randomized 412 postmenopausal women, average age 63, with low BMD to receive denosumab, placebo or Fosamax. The purpose of the study was to determine the safety and efficacy of denosumab on lumbar spine BMD compared with placebo at 12 months. The doses of denosumab evaluated included 6, 14 or 30 mg every three months or 14, 60, 100 or 210 mg every six months. Denosumab was administered by subcutaneous injection. Patients receiving Fosamax followed the approved indication and oral dosing instructions of 70 mg once weekly.
About Osteoporosis
In the United States, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis. Of the 10 million Americans estimated to have osteoporosis, eight million are women and two million are men. In addition, one in two women and one in four men over age 50 will have an osteoporosis-related fracture in their remaining lifetime.
About Providence Portland Medical Center
Providence Portland Medical Center is part of Providence Health System, the state's largest health system and second-largest private employer. Providence Portland is recognized for excellence in patient care and research in such areas as cancer, heart, orthopedics, women's health, rehabilitation services and behavioral health. Providence Health System in Oregon, ranked as the fourth most integrated health care system in the nation, offers a comprehensive array of health and education services through its seven hospitals, medical clinics, health plans, long-term care facilities and home health services. Visit providence/oregon.
Contact: Paula Gunness
paula.gunnessprovidence
Porter Novelli /
View drug information on Fosamax.
пятница, 1 июля 2011 г.
Elevated Levels Of Cobalt And Chromium Found In Offspring Of Moms With Metal-on-Metal Hip Implants
Women with metal-on-metal hip implants, where both the ball of the joint and the surface of the socket are made of metal, pass metal ions to their offspring during pregnancy, according to a study by researchers at Rush University Medical Center. The ions are the result of wear and corrosion as the metal parts rub against one another.
The data showed a correlation between levels of cobalt and chromium components of metal implants in mothers and their babies at the time of delivery.
The study will be presented March 9 at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans.
"We don't know whether metal ions pose any health risks for pregnant women and their babies," said Dr. Joshua Jacobs, professor and chairman of orthopedic surgery at Rush, "but as metal-on-metal implants increase in popularity and use, especially among young, active patients, women of child-bearing age and their doctors need to be aware of these findings when considering options for hip replacements."
Jacobs and his colleagues evaluated three women who had metal-on-metal hip implants and gave birth two to six years after their surgeries.
Maternal and umbilical cord blood was obtained at the time of delivery and tested for blood serum concentrations of titanium, nickel, cobalt and chromium using inductively coupled plasma mass spectrometry, a highly sensitive technique that can detect trace amounts of metals in biological samples.
The researchers found that mothers with metal-on-metal implants and their offspring had significantly higher levels of chromium and cobalt compared with a control group of seven women and their offspring who were also tested at the time of delivery. Moreover, the levels of these metals in the blood of mothers with implants correlated with the levels found in the umbilical cords. Cobalt levels in newborns were about half that in the mothers' blood, while chromium levels were about 15 percent of the mothers' chromium levels. In the control group, no correlation existed.
The lower levels in the umbilical cords indicated that the placenta provided at least some barrier to the transfer of metal ions from mother to fetus, but not a complete barrier, Jacobs said.
Levels of titanium or nickel showed no significant difference between the two groups.
It is unknown whether metal ions in the bloodstream for pregnant mothers, developing fetuses or newborns pose any significant health risk. According to Jacobs, medical device companies are working to improve the wear and corrosion properties of metal implants to reduce the release of metal ions.
"Any advancements in this area will directly benefit patients," Jacobs said. Rush University Medical Center has an active research program testing different materials for components in joint replacement devices.
Total joint replacement is a surgical procedure in which the patient's natural joint is replaced with an artificial one, made of a combination of plastic, metal, and/or ceramic. Over 300,000 first-time total hip replacements are performed each year in the U.S.
Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).
Source: Rush University Medical Center
The data showed a correlation between levels of cobalt and chromium components of metal implants in mothers and their babies at the time of delivery.
The study will be presented March 9 at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans.
"We don't know whether metal ions pose any health risks for pregnant women and their babies," said Dr. Joshua Jacobs, professor and chairman of orthopedic surgery at Rush, "but as metal-on-metal implants increase in popularity and use, especially among young, active patients, women of child-bearing age and their doctors need to be aware of these findings when considering options for hip replacements."
Jacobs and his colleagues evaluated three women who had metal-on-metal hip implants and gave birth two to six years after their surgeries.
Maternal and umbilical cord blood was obtained at the time of delivery and tested for blood serum concentrations of titanium, nickel, cobalt and chromium using inductively coupled plasma mass spectrometry, a highly sensitive technique that can detect trace amounts of metals in biological samples.
The researchers found that mothers with metal-on-metal implants and their offspring had significantly higher levels of chromium and cobalt compared with a control group of seven women and their offspring who were also tested at the time of delivery. Moreover, the levels of these metals in the blood of mothers with implants correlated with the levels found in the umbilical cords. Cobalt levels in newborns were about half that in the mothers' blood, while chromium levels were about 15 percent of the mothers' chromium levels. In the control group, no correlation existed.
The lower levels in the umbilical cords indicated that the placenta provided at least some barrier to the transfer of metal ions from mother to fetus, but not a complete barrier, Jacobs said.
Levels of titanium or nickel showed no significant difference between the two groups.
It is unknown whether metal ions in the bloodstream for pregnant mothers, developing fetuses or newborns pose any significant health risk. According to Jacobs, medical device companies are working to improve the wear and corrosion properties of metal implants to reduce the release of metal ions.
"Any advancements in this area will directly benefit patients," Jacobs said. Rush University Medical Center has an active research program testing different materials for components in joint replacement devices.
Total joint replacement is a surgical procedure in which the patient's natural joint is replaced with an artificial one, made of a combination of plastic, metal, and/or ceramic. Over 300,000 first-time total hip replacements are performed each year in the U.S.
Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).
Source: Rush University Medical Center
Подписаться на:
Комментарии (Atom)