Introduction: Flipped classroom models, which use active, case-based discussion, have shown promise across graduate medical education. Previous literature demonstrates that transitioning to a flipped classroom model resulted in significant increases in overall Orthopaedic In-Training Examination (OITE) scores. This observational study retrospectively compares foot and ankle OITE scores for orthopaedic surgery residents before and after implementation of a flipped classroom curriculum. Methods: This retrospective study reviewed OITE scores for orthopaedic residents, comparing a lecture-based curriculum (n = 49) to a flipped classroom curriculum (n = 61). Residents who started their second year in July 2020 or later were defined as treated. The curriculum is given to the postgraduate year-2 (PGY2) residents only. Percentage of correct foot and ankle questions (F&A) were analyzed via mixed-effects models using random-subject intercepts. Fixed effects included PGY, overall performance on other sections, and flipped classroom status. All statistical analyses were performed in R version 4.4.1. Results: Residents in the flipped classroom cohort demonstrated a statistically significant increase in F&A questions answered correctly. The average increase was 7% (95% confidence interval: 4%, 10%; p < 0.001). This improvement trend became clearly visible in PGY3 and grew stronger in senior residents. Specifically, PGY3 residents improved their mean percentage correct from 62.26% to 66.07% (p = 0.16). PGY4 residents improved from 69.16% to 74.83% (p = 0.013), and PGY5 residents improved from 69.03% to 75.53% (p = 0.006). Historically, approximately 75% of traditional PGY5 residents scored lower on the F&A section than on the rest of the examination. Conversely, in the flipped classroom group, approximately 75% of PGY4 and PGY5 residents scored higher on the F&A section compared with other sections Discussion: The implementation of a flipped classroom model was associated with a statistically significant improvement in resident performance on the F&A section of the OITE. The educational benefits of this curriculum appear cumulative over the course of residency, with the most substantial performance gains realized by senior residents in their fourth and fifth years of training. Level of Evidence: Level III , Observational Study. See Instructions for Authors for a complete description of levels of evidence.
Single‐Stage Modified Postauricular Flap Reconstruction for a Traumatic Helical Rim Defect Following a Human Bite: A Case Report
ABSTRACT Traumatic defects of the helical rim caused by human bites present significant reconstructive challenges because of tissue loss, infection risk, and the need to preserve auricular contour and symmetry. We report a 27‐year‐old man who presented with a middle‐third defect of the left helical rim following necrosis of an initially sutured avulsed flap caused by a human bite injury. After discussion of reconstructive options, including chondrocutaneous advancement and staged flap procedures, a single‐stage modified postauricular flap without skin grafting was selected to preserve ear size and minimize donor‐site morbidity. The flap was successfully inset with restoration of the helical contour, and postoperative follow‐up demonstrated stable healing, preserved auricular shape, and high patient satisfaction without complications. This case highlights that a single‐stage modified postauricular flap is a reliable and patient‐centered option for reconstruction of traumatic helical rim defects following human bite injuries.
Extracorporeal magnetotransduction therapy as an adjunctive and primary modality for bone healing: a scoping review of current evidence
Reactive granulomatous dermatitis as a clinically relevant and unifying term: a retrospective review of clinical features, associated systemic diseases, histopathology and treatment for a series of 65 patients at Mayo Clinic
Abstract Background Reactive granulomatous dermatitis (RGD) is an umbrella term used to describe interstitial granulomatous dermatitis (IGD), palisaded neutrophilic and granulomatous dermatitis (PNGD), and interstitial granulomatous drug eruption (IGDR). Objective The aim of this study was to describe systemic associations of RGD, explore possible associations between histopathologic findings and systemic RGD associations and determine clinical relevance of RGD subtypes. Methods We retrospectively studied clinical and histopathologic characteristics of patients with RGD from 1990 through 2020. Results Of 65 patients with RGD (41 women, 24 men; median age at diagnosis, 62 years), 37 had IGD, 26 had PNGD, and 2 had IGDR. Fifty patients (76.9%) had an associated systemic condition; rheumatologic conditions were identified for 34 (52.3%) patients. The associated systemic condition occurred before RGD in approximately 75% of patients. Statistical analyses did not show significant associations between specific subtypes of RGD and systemic diseases or treatment response, and specific histopathologic findings were not predictive of an associated systemic disease. Conclusions Although most patients with RGD had an associated systemic condition, subtypes of RGD did not correlate with systemic associations, lending support to the use of the umbrella term RGD .
Background Uterine leiomyomas (fibroids) are benign smooth muscle cell tumors of the uterus that affect a large percentage of reproductive aged women, contribute to infertility, excessive menstrual bleeding, and represent the leading cause of hysterectomy (~70%). Despite their importance, the mechanisms that promote fibroid growth are still not well‐understood. Fibroids are comprised of smooth muscle cells (SMCs) and fibroblasts and their growth is modulated by hormones including estrogen and progesterone. Intracellular calcium [Ca 2+ ] i signaling is a key aspect of SMC physiology in promoting contractility, cell proliferation, and fibrosis: aspects relevant to fibroid biology. While [Ca 2+ ] i regulation in normal myometrium is well characterized, this has not been explored in fibroids. The goal of this study was to explore [Ca 2+ ] i regulation in fibroid SMCs and the effect of sex steroids towards obtaining insights into tumor progression. Methods Cells were enzymatically isolated from normal myometrium and select fibroids of different sizes from patients undergoing myomectomy at Mayo Clinic, Rochester, MN (IRB approved). [Ca 2+ ] i was measured using fura‐2/AM and real‐time fluorescence microscopy. The contribution of Ca 2+ influx vs. intracellular pathways in the responses to 1uM oxytocin were assessed using pharmacological inhibitors/activators. Cells were pretreated with vehicle, 1nM estrogen, or 1nM progesterone to assess the effect of sex steroids. Results Fibroid‐derived cells showed a greater contribution of Ca 2+ influx pathways in their responses to oxytocin than normal myometrium. Here, the Ca 2+ ‐activated chloride channel TMEM16A (Ano1) was found to be contributory, with Western analysis showing higher levels of Ano1 in fibroids. Exposure to estrogen resulted in significantly higher [Ca 2+ ] i responses compared to cells treated with vehicle or progesterone, although progesterone did enhance [Ca 2+ ] i responses as well. Estrogen increased Ano1 expression. Cell proliferation was also increased in fibroid cells. Conclusions Exposure to estrogen and progesterone enhances oxytocin induced [Ca 2+ ] i responses of fibroid‐derived cells, potentially via increased TMEM16A (Ano1). Such increases may further contribute to the observed hormone‐induced enhancement of fibroid cell proliferation. Menstrual cycle fluctuations in reproductive aged women may thus contribute to the progression of fibroids. Greater understanding of calcium signaling pathways such as Ano1 in fibroid tissue may allow for novel therapeutic targets in uterine leiomyomas. Support or Funding Information Supported by NIH grants R25 GMO75148 (JLR), R01 HL088029 (YSP), and R01 HL56470 (YSP). This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .
Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)
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