United States

Abstract Title
Non-Surgical Management of a Partial ACL Tear with Platelet-Rich Plasma: A Case Report

Background
Anterior cruciate ligament (ACL) injuries are common in pivoting sports and often result in long-term functional limitations. While complete ACL tears typically require surgical intervention, partial tears in active individuals may benefit from biologic therapies. We present a case of a recreational athlete with a partial ACL tear managed successfully with platelet-rich plasma (PRP) therapy.

Methods
A 29-year-old male recreational basketball player presented with acute right knee pain after landing awkwardly from a jump. He reported a mild &quot;pop&quot; sensation, immediate swelling, and difficulty bearing weight. He had no prior history of major knee injury. Initial conservative management included RICE and NSAIDs. Due to persistent pain and instability after 3 weeks, he was referred for further evaluation.

Results
Physical examination revealed mild effusion, tenderness along the medial joint line, and mild limitations in flexion and extension. Lachman test was mildly positive; anterior drawer test showed minimal translation. MRI demonstrated a partial tear of the ACL involving approximately 50% of the ligament fibers, with intact menisci and collateral ligaments. No chondral defects were noted. Given the partial nature of the injury and the patient&#39;s desire to avoid surgery, PRP therapy was recommended. The patient received two ultrasound-guided intra-ligamentous PRP injections over a four-week interval.

Conclusion
At the 3-month follow-up, the patient reported significant improvement in knee stability and function, with minimal pain. MRI demonstrated improved fiber continuity and decreased signal intensity in the ACL region. By 4 months post-injection, the patient had resumed non-contact basketball activity and continued with progressive strengthening and proprioception training. This case highlights the potential role of PRP therapy as a non-surgical treatment option in partial ACL tears, particularly in motivated patients seeking to return to activity. Further research is needed to better define indications and long-term outcomes of biologic therapies in ligamentous injuries.

AMA Research Challenge 2025 

Non-Surgical Management of a Partial ACL Tear with Platelet-Rich Plasma: A Case Report

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AMA Research Challenge 2024 

Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

Abstract Title
Non-Surgical Management of a Partial ACL Tear with Platelet-Rich Plasma: A Case Report

Background
Anterior cruciate ligament (ACL) injuries are common in pivoting sports and often result in long-term functional limitations. While complete ACL tears typically require surgical intervention, partial tears in active individuals may benefit from biologic therapies. We present a case of a recreational athlete with a partial ACL tear managed successfully with platelet-rich plasma (PRP) therapy.

Methods
A 29-year-old male recreational basketball player presented with acute right knee pain after landing awkwardly from a jump. He reported a mild "pop" sensation, immediate swelling, and difficulty bearing weight. He had no prior history of major knee injury. Initial conservative management included RICE and NSAIDs. Due to persistent pain and instability after 3 weeks, he was referred for further evaluation.

Results
Physical examination revealed mild effusion, tenderness along the medial joint line, and mild limitations in flexion and extension. Lachman test was mildly positive; anterior drawer test showed minimal translation. MRI demonstrated a partial tear of the ACL involving approximately 50% of the ligament fibers, with intact menisci and collateral ligaments. No chondral defects were noted. Given the partial nature of the injury and the patient's desire to avoid surgery, PRP therapy was recommended. The patient received two ultrasound-guided intra-ligamentous PRP injections over a four-week interval.

Conclusion
At the 3-month follow-up, the patient reported significant improvement in knee stability and function, with minimal pain. MRI demonstrated improved fiber continuity and decreased signal intensity in the ACL region. By 4 months post-injection, the patient had resumed non-contact basketball activity and continued with progressive strengthening and proprioception training. This case highlights the potential role of PRP therapy as a non-surgical treatment option in partial ACL tears, particularly in motivated patients seeking to return to activity. Further research is needed to better define indications and long-term outcomes of biologic therapies in ligamentous injuries.

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MicroRNAs (miRNAs) are critical regulators of gene expression. The co-expressed miRNAs, miR-24 and miR-27, are known to restrain T helper 2 (Th2) cell differentiation and the production of cytokines like Interleukin-4 (IL-4), which are central to allergic diseases. However, a comprehensive map of their target network is incomplete. High-throughput sequencing of RNA isolated by crosslinking immunoprecipitation (HITS-CLIP) can identify miRNA targets transcriptome-wide, but analyzing these large datasets to find differential targets between conditions remains a major computational challenge. To address this, we developed DeepRNA-Reg, a novel deep learning algorithm designed for high-fidelity comparative analysis of HITS-CLIP experiments.

A Deep-Learning Based Approach Uncovers Novel Mediators of Micro-RNA Restraint of Type-2 Immunity

Background 
Medication adherence is a complex and interconnected issue. A patient is considered adherent to medication if taking 80% of their prescribed medication(s). Medication adherence places a huge economic burden on healthcare systems. An estimated annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44,190 in 2015.

Aim 
Our systematic review was to investigate factors affecting medication non-adherence in the adult US population (>18 years) from published literature in the last 10 years (2012-2023). 

Methods 
We performed a systematic review using the PRISMA protocol and MOOSE guidelines to identify articles describing factors affecting medication non-adherence. Using the PubMed search engine, we identified English, full-text, observational studies from 2012 to the present using the following keywords: medication non-adherence, economic impact, factors associated with drug non-adherence, and cost-related medication nonadherence. The primary endpoint was to screen, collect and analyze the data on the factors, burden, and short and long-term impact of medication non-adherence on healthcare. We have also evaluated the methods of assessment and measures of adherence. 

Results 
Of the initial pool of 982 studies describing information medication non-compliance, we found 10 full-length studies describing factors, burden, long-term impact, and method and measure of drug compliance. We found that cost-related non-adherence in adults >65 years of age, diabetics, cardiovascular disease, and hypertension had higher mortality compared to drug-adherent patients. The factors that contribute to medication compliance are broadly classified into 
patient-specific, illness-specific, medication-related, healthcare-related, sociocultural, as well as logistical and financial factors. A Systematic Review investigating cost and regimen complexity affecting medication Adherence in the elderly that included 9 studies identified patient-related factors such as disease-related knowledge, health literacy, and cognitive function, drug-related factors such as adverse effects and polypharmacy, and other factors.

Conclusion 
Medication adherence places a huge economic burden on the healthcare system's specialty amongst the population over >65 years of age. Indicators are always available to identify in each patient like polypharmacy, chronic disease, mental health, etc but those are needed to be recognized at an early level to mitigate the burden of non-adherence and reduce mortality in specific groups of the population.

Factors associated with medical non-adherence - a systematic review

Background
Atrial fibrillation (AF) affects over 10 million people in the United States and is commonly managed via antiarrhythmic drug (AAD) therapy for symptom and rhythm control. While AADs are known to improve cardiac outcomes in AF patients, they often require a three-day inpatient hospitalization to initiate treatment due to the rare risk (<0.6%) of QT prolongation. These hospitalizations can contribute significantly to healthcare costs. The goal of this case series is to present a novel software platform that supports remote AAD therapy initiation and ECG monitoring of varying durations, offering a safe and cost-effective alternative to inpatient care.

Methods
A total of 17 AF patients (7 female, 10 male) underwent software-supported AAD titration (1 dofetilide, 2 amiodarone, 14 sotalol). Baseline ECG parameters were recorded and reviewed by providers who either accepted, modified, or rejected the automated measurements through the SafeBeat Rx software portal. The physicians then approved, modified, or rejected the algorithm-recommended AAD dose, generated based on the manufacturer’s drug label. Heart rate and QTc following each dose were monitored for proarrhythmic effects. 

Results
Average baseline QTc, heart rate, and creatinine averaged 409.76 ± 20.56 ms, 83.47 ± 19.77 beats/min, and 0.95 ± 0.22 mg/dL, respectively (Table I). Remote cardiac interval monitoring ranged from 3 to 22 days. In total, 11 patients were extended to long-term remote monitoring following the drug titration process. No adverse events were reported, and all patients achieved sinus rhythm.

Conclusion
This case series establishes remote and extended QT-interval monitoring during AAD therapy initiation. All patients experienced safe and effective dose administration, suggesting the software platform has the potential to facilitate long-term cardiac therapeutic monitoring of commonly prescribed AADs.

Software-Supported Remote Monitoring of Anti-Arrhythmic Drug Therapy in Atrial Fibrillation Patients: A Case Series

Background
Prurigo nodularis (PN) is a chronic inflammatory, pruritic skin disorder characterized by raised papules and hyperkeratotic nodules. PN has been linked to malignancy, though cancer types and mechanisms remain unclear. To analyze the relationship between PN and skin cancer, we used the All of Us Research Program, a U.S.-based electronic health record and genomic database with data from over one million participants, to assess PN and cutaneous neoplasms.
Methods
We identified 869 individuals with PN using concept ID 4272156 and propensity matched them to two controls (n = 1738) based on age, sex, race, and ethnicity. Diagnoses of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and melanoma were identified through curated concept sets and relevant concept IDs to maximize capture. We extracted demographic and clinical variables, smoking status, insurance, income, family skin cancer history, and healthcare use.
Univariate associations were tested using χ2 or Fisher’s exact t-test. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Multivariable logistic regression models were adjusted for age, race, ethnicity, sex, income, insurance, smoking status, family history of skin cancer, and healthcare utilization.
Results
PN cases had a higher prevalence of any NMSC (16.3% vs 5.2%; P < 0.001), with significant increases in BCC (11.4% vs 3.9%; P < 0.001), SCC (9.7% vs 1.8%; P < 0.001) and melanoma (4.3% vs 1.5%; P < 0.001). Univariable logistic regression showed PN was associated with increased odds of BCC (OR 3.16; 95% CI 2.29–4.35; P < 0.001), SCC (OR 5.89; 95% CI 3.87– 8.97; P < 0.001) and melanoma (OR 2.93; 95% CI 1.76–4.87; P < 0.001). These associations persisted after multivariable adjustment for demographics, risk factors, and healthcare utilization, with adjusted OR (aOR) 3.31 (95% CI 2.33–4.69; P < 0.001) for BCC, aOR 6.09 (95% CI 3.89– 9.53; P < 0.001) for SCC and aOR 3.01 (95% CI 1.77–5.13; P < 0.001) for melanoma.
Conclusion
Chronic scratching and repeated trauma to the skin, hallmarks of PN, may lead to inflammation and compromised skin barrier integrity, potentially promoting keratinocyte carcinogenesis. PN is associated with a chronic Th2-skewed inflammatory milieu—characterized by elevated IL-4 and IL-13, and prolonged use of immunosuppressants may similarly impair antitumor immunity. Future PN studies should examine IL-4/IL-13 pathway inhibitors on long-term cancer risk. Given the potential association with cutaneous neoplasms, routine skin exams may be appropriate in individuals with long-standing or extensive PN.

Risk of Skin Cancer in Prurigo Nodularis: A Case-Control Study Using the All of Us Research Program



Background:
In people with chronic use of cannabis, Cannabinoid Hyperemesis Syndrome (CHS) is an illness associated with symptoms of cyclic vomiting, nausea, and abdominal pain. Conventional antiemetic medications frequently offer very modest relief. Topical capsaicin works by activating the transient receptor potential vanilloid 1 (TRPV1) in response to high temperatures and substance P regulation. This leads to pain relief by depleting substance P over time. Capsaicin has recently drawn interest since it mimics heat exposure from hot showers, which has been shown to reduce symptoms. This study was performed to investigate the effect of topical Capsaicin in treating CHS. 

Methods:
We searched PubMed, Embase, and Scopus and selected nine articles that were performed between 2013 and 2024, including clinical trials, case reports, and case series that evaluated capsaicin use in patients with CHS. Information about Caspacicin dosage, formulation, and adverse effects was studied. 

Results:
A total of 196 patients from nine selected studies were included. We found that applying 0.025%–0.1% capsaicin cream to the abdomen or thorax consistently resulted in rapid symptom alleviation (within 30–90 minutes). Capsaicin found to be better than conventional antiemetics in terms of symptom recurrence and time to resolution. Localized burning was the most frequent side effect, and no major adverse effects were observed in any of the studies. The effectiveness of Capsaicin was seen whether or not cannabis was stopped.

Conclusion:
We found that topical Capsaicin is a safe, quick-acting, and affordable supplement for traditional antiemetics in CHS. Its symptom-relief characteristics and convenience of usage make it particularly helpful in emergency situations. To develop conclusive treatment procedures and maximize the use of Capsaicin as a first-line treatment for CHS, more randomized trials are required.



The Effectiveness of Topical Capsaicin for Management of Cannabinoid Hyperemesis Syndrome: A Literature Review 


Background
Normal pressure hydrocephalus (NPH) is commonly treated with ventriculoperitoneal shunting, though shunt revisions remain a frequent complication and wound dehiscence, albeit rare, may lead to full revision surgery. The Valve-Agnostic Cranial Implant (VACI, “InvisiShunt®” Longeviti, Inc.), is designed to countersink ventriculoperitoneal shunt valves, to reduce dehiscence and the need for revision. These were first implanted in 2019 and offer a low-profile alternative to traditional subgaleal shunt placement. However, only one prior clinical trial report of its use exists to date (n=25). This case series of twenty-five patients seeks to add to the existing literature on VACI efficacy in NPH patients.
Methods
Twenty-five patients diagnosed with NPH underwent implantation of the VACI (InvisiShunt®), at a mean age of 76.4 ± 10.1 years. This case series was conducted at Hoag Medical Center, Newport Beach, CA, USA, from November 2022 to March 2023. Follow-up ranged from 4 to 24 months. Patient demographics, comorbidities, preoperative symptoms, surgical details, postoperative outcomes, and complications were collected and analyzed.
Results
No intraoperative complications occurred. Six patients demonstrated either altered mental status, abdominal pain, or generalized weakness, unrelated to the implant. There were no infections reported within the 30-day post-operative period and up to 24 months of follow-up. There was one incidence of wound dehiscence that necessitated full revision surgery. Patients underwent an average of 2.3 ± 1.4 reprogramming events. Post-operative outcomes included improvements in gait disturbance (n=18; 72.0%) and urinary incontinence (n=9; 36.0%), and cognitive disturbances (n=8; 32%).
Conclusion
Our findings support the potential of VACI as a viable and safe low-profile alternative to traditional subgaleal shunt valve placement for NPH treatment, with no increase in morbidity. Further research with extended follow-up is needed to confirm these preliminary results and evaluate long-term efficacy.

Valve-Agnostic Cranial Implant (InvisiShunt®) in Normal Pressure Hydrocephalus Ventriculoperitoneal Shunting: A Case Series

Objectives:
• Recognize histiocytoid Sweet syndrome (HSS) as a potential dermatologic manifestation of MDS and AML.
• Assess the role of hypomethylating agents (decitabine and azacitidine) in triggering HSS.

Introduction:
Sweet syndrome (SS) is an acute febrile neutrophilic dermatosis, and its histiocytoid variant (HSS) is a rare, yet increasingly recognized form characterized as an infiltrate of immature myeloid cells that resemble histiocytes. Common triggers of HSS discussed in literature include underlying hematologic malignancies, especially MDS, as well as certain drugs, including hypomethylating agents [1, 2, 3, 4]. These cases mainly focus on the initial presentation of HSS but to our information, no published case reports have described occurrence and recurrence of HSS by two distinct hypomethylating agents.
We present a case of elderly female patient with MDS with progression to AML who initially presented with biopsy-diagnosed HSS and had recurrence of HSS after initiation of Azacitadine. Recognizing this rare syndrome and its common triggers can have significant diagnostic and therapeutic implications.

Case Presentation:
An 83-year-old woman with a history of DCIS and newly diagnosed MDS-EB-2, who had completed her first cycle of decitabine one week earlier, presented with a painful ulcerative lesion on the left lower extremity along with widespread purple papules and plaques. A skin punch biopsy demonstrated histiocytic and neutrophilic inflammation consistent with the diagnosis of Histiocytoid Sweet syndrome. Patient was initially treated with topical steroids with improvement of her dermatologic symptoms. Of note, during this time, patient did not receive any additional Decitabine therapy and had lab findings significant for 28% blasts, consistent with progression of disease to AML. Given new diagnosis AML, patient was started on Azacitidine (and Venotoclax) with recurrence and worsening of her rash requiring topical and oral steroids.

Discussion:
This case highlights several important and underrecognized aspects of histiocytoid Sweet syndrome (HSS) in myeloid malignancies. HSS is most often triggered by underlying hematologic disease, such as MDS or AML, and by certain chemotherapy agents. While decitabine and azacitidine have both been linked to Sweet syndrome, we found no prior reports of sequential HSS flares from two different hypomethylating agents in the same patient.
Our patient first developed biopsy-proven HSS shortly after receiving decitabine and during progression of MDS to AML. The timing suggests that both the progression of her leukemia and exposure to decitabine may have played a role. It remains unclear whether worsening hematologic disease itself increases the risk of HSS, or whether drug exposure simply unmasks the underlying inflammatory response.
The second episode, following initiation of azacitidine, is also notable. While azacitidine-induced Sweet syndrome has been documented, recurrence with another hypomethylating agent has not been reported. Our case suggests that in some patients, the broader class of hypomethylating agents may predispose to recurrence of HSS, especially when underlying disease is active.
Overall, this case adds to the limited literature on drug-induced HSS and raises important clinical questions: Does disease progression increase susceptibility to Sweet syndrome? Should clinicians be cautious about recurrence of Sweet syndrome when re-exposing patients to similar hypomethylating agents? Answering these questions will require further study, but awareness of this potential complication is key to early recognition and treatment.

Sweet Troubles in AML: Sequential Histiocytoid Sweet Syndrome Triggered by Hypomethylating Therapy

The COVID-19 pandemic accelerated telemedicine use, offering critical healthcare access for individuals with chronic illnesses while alos exposing disparities among marginalized communities. In Flint, Michigan, a city with high poverty rates and ongoing recovery from the Water Crisis, our study sought to understand community perceptions of telemedicine. The first phase focused on English-speaking participants, revealing barriers such as lack of equipment, internet access, and awareness, alongside benefits of convenience and safety. This second phase centers on spanish-speaking residents to explore their unique, culturally specific challenges and ensure their voices shape equitable healthcare solutions.

COVID-19 and Telemedicine: Perspective from the Spanish-speaking Community in Flint, MI: A qualitative approach

In the U.S., firearms are a leading cause of traumatic injury and mortality. Firearm reinjury significantly increases morbidity, healthcare utilization, and economic burden. Hospital-based violence intervention programs (HVIPs) meet firearm injury victims in a teachable moment after injury and connect patients with peer support and community services to prevent reinjury. Identifying factors that increase risk for reinjury can guide HVIP risk stratification and harm reduction strategies. Low socioeconomic status (SES) increases firearm injury risk and may confound other risk factors. Deprivation index (DI) estimates material deprivation in a census tract, correlating with SES. We describe a cohort of patients enrolled in a HVIP, including those with a history of firearm injury, to identify factors associated with reinjury.

Patients aged 0-44 presenting at our region’s level 1 adult and pediatric trauma centers for a firearm injury from October 2024 to August 2025 were eligible for enrollment. Patients completed surveys on demographics, current and prior injury, and social determinants of health. An item-level analysis of participant responses was conducted via multivariable logistic regression at 95% confidence, using prior firearm injury as predictor, adjusted for age and gender, and then compared to separate analysis also adjusting for DI. Base OR and DI – adjusted OR was compared to detect significant change, defined a priori as > 10% difference in log-OR.

A total of 122 patients enrolled, 32 with prior firearm injury. The mean age was 26.7 years and 79.5% were male. These, along with low DI, were significantly associated with having prior firearm injury. History of firearm injury was associated with not having a high school degree, knowing the perpetrator, having a family member who was previously a victim of gun violence, incident occurrence near home, and self-reported depressive symptoms. Patients who were employed were less likely to have a history of firearm injury. DI-adjusted analysis weakened an initial association with educational attainment.

These findings are supported by prior prospective investigations which identified low SES and related factors as risk factors for reinjury. Knowing the perpetrator and having a family member injured by firearms may be novel risk factors. Educational attainment was confounded by DI on this analysis. The protective effect of employment supports the goal of HVIPs to connect patients with wraparound services, including job training and employment assistance. Future investigations should evaluate novel risk factors and risk stratification tools prospectively to overcome limitations of cross-sectional design.

Identifying factors associated with firearm reinjury in a novel hospital-based violence intervention program

Background: Since 2020, first-year students at Geisinger Commonwealth School of Medicine students were required to attend the Northeastern Pennsylvania (NEPA) Trans Health Conference, an education forum where students learn directly from community members about their health experiences, fostering cultural and narrative humility to reduce the psychological harm and medical neglect gender-diverse people face. (1, 2) In 2025, attendance became optional, with the choice to either attend the conference or complete alternative coursework. Students subsequently submitted written reflections about what they learned and how it will impact their patient advocacy. 
Methods: We conducted a qualitative cross-sectional analysis of reflections submitted by medical students who attended the NEPA Trans Health conference or completed alternative coursework in 2024 and 2025. Researchers employed a constructivist grounded theory methodology to independently code de-identified reflections and applied the Delphi method to achieve consensus. (3, 4) 
Results: Reflections from 2024 demonstrated increased knowledge about the lived experience of transgender people in support of narrative humility. (5) They also demonstrated an understanding of gender-diverse patients’ needs and the ability to apply health equity frameworks to patient advocacy. Preliminary data from 2025 reveals lower conference attendance compared to 2024. We hypothesize that students completing the alternative assignment will have more cursory responses. (6) 
Discussion: The opportunity for students to learn directly from gender-diverse communities helps learners appreciate their lived experiences. This perspective is necessary to provide sufficient care across all patient populations. Early exposure to gender-diverse populations facilitates students’ self-directed life-long learning, as required for LCME accreditation. (7)

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