If you asked doctors how to treat chronic osteomyelitis, they would likely all say the same thing: antibiotics, amputation, or bone grafts. However, if you asked the scientists at Galeazzi Orthopedic Institute, you might get told that the best way to treat chronic osteomyelitis is with bioactive glass S53P4, one of the most recent and promising medical advancements for bone treatment. But what makes bioactive glass S53P4 so special? 

First off, we need to understand what osteomyelitis is, and subsequently what chronic osteomyelitis is. Osteomyelitis is an infection of the bone tissue which can occur due to bone damage, surrounding soft tissue damage, or nearby surgery which allows pathogens to penetrate the protective outer layer of the bone. Once within the bone, pathogens can cause varying degrees of bone loss as the infection progresses. Ultimately, this bone loss can result in limb amputation, sepsis, or even death as a progressed infection can result in organ failure. 

As mentioned above, the traditional treatments for osteomyelitis consist of antibiotics to kill the responsible pathogen and stop the spread of the infection; however, antibiotics are not always the best option as they can affect other microorganisms in the body. Furthermore, overuse of antibiotics in a clinical setting has allowed for the development of antibiotic resistant pathogens, such as methicillin resistant staphylococcus aureus (MRSA), which will eventually render antibiotics useless. Furthermore, higher degrees of bone loss can result in a very weak bone which cannot be treated with antibiotics alone. So, what are our other options? 

Clinically, if you want to avoid losing a limb, the next best options would be antibiotic loaded polymethylmethacrylate beads (PMMA) or bone grafting. Both of these methods work through the surgical removal of the necrotic bone tissue and the replacement of that bone tissue with PMMA or fresh bone from a graft.

 

However, there are some drawbacks as these methods are only designed to fill the bone cavity left behind from the infection, provide limited local antibiotics, and take a long time to produce results. Sadly, bone doesn’t grow overnight! So, what if there was something that could fill the bone cavity, stimulate bone growth, and was naturally antibiotic resistant?

Enter bioactive glass S53P4 (BAG S53P4). Bioactive glass itself is a silica based biodegradable glass which has been shown to have antibiotic, osteoconductive, and angiogenic properties. Which is essentially a way of saying it stimulates bone growth and blood vessel growth all while repelling those pesky pathogens! BAG S53P4 takes it a step further and is composed of SiO2, Na2O, CaO, and P2O5 which further stimulates bone growth by chemically binding to surrounding bone. This almost sounds too good to be true, so researchers at Galeazzi Orthopedic Institute set out to understand how BAG S53P4 is so effective and determine its safety in a clinical setting. 

To determine the source of BAG S53P4s antibiotic properties and to evaluate its safety, the research team took 27 patients with chronic long bone osteomyelitis from antibiotic resistant pathogens and treated them using the bioactive glass.  From their study, they were able to determine that the antibiotic resistant properties of BAG S53P4 stems from its contact with an aqueous solution. By contacting an aqueous solution, BAG S53P4 activates the release of ions which increase the surrounding pH. This increased pH creates a hostile environment for bacterial growth stopping infection in its tracks. As a result, 90% of the treated patients showed no signs of infection after 18 months. X Rays of the patient treated with BAG S53P4 were also taken over the course of 18 months. From these X Rays, the team was able to determine that the vascularization and bone growth seen in these patients far surpassed that of previous methods and was equally safe in its application. 

Ultimately, this research determined that BAG S53P4 was a safe and effective treatment for patients suffering from chronic osteomyelitis. So next time you’re asked how to treat chronic osteomyelitis, consider the less traditional route and give BAG S53P4 a try!  

Source:

Drago, L., Romanò, D., De Vecchi, E., Vassena, C., Logoluso, N., Mattina, R., & Romanò, C. L. (2013). Bioactive glass BAG-S53P4 for the adjunctive treatment of chronic osteomyelitis of the long bones: An in vitro and prospective clinical study. BMC Infectious Diseases, 13(1), 1-8.

https://pubmed.ncbi.nlm.nih.gov/24325278/

Traveling through the aerial space is how I moved across the city during my visit to La Paz, Bolivia, last summer. No, I do not have wings or flying powers. I did not rent a helicopter or any kind or aircraft either. What I did was along with what hundreds of thousands of local citizens do every day: take rides in aerial lifts, also known as gondola lifts or cable cars. Every ride in the cabins of Mi Teleferico has been an amazing experience. Have you ever been to a ski/snowboarding resort and taken a lift or have riden a cable car at Six Flags Over Georgia? I confess that at Six Flags Over Georgia was my first time ever riding the Skyride or so-called gondola lift. This might have not crossed your mind, but that experience magnified what happened to me this past summer in La Paz.

Since the early twenty century, modern cities have adopted different types of massive public transportations such as on the ground trains or underground subway trains. In general, these transportation systems are optimal for cities on relatively flat surfaces. Sometimes, lines of ferry boats are implemented when navigable bodies of water such as rivers or lakes could be used around cities. However, La Paz’s geography is quite different. La Paz is a hilly city built in a valley like a bowl with streets and avenues climbing steep hills and without navigable bodies of water. Therefore, in La Paz, a network of cable car lines has been considered the best option. MiTeleferico, the transportation authority, manages the network of cable cars which has been implemented as a system of mass transportation since about a decade ago.

All relate back to Mi Teleférico in La Paz, Bolivia, which is also a home city deep into the heritage of my parents and family and by extension deep into mine as well. This past summer I had the opportunity once again to travel to Bolivia and visit my extended family. Bolivia is located in South America and is one of the two countries, along with Paraguay, that is landlocked. Bolivia has many interesting attractions both for native people and tourists.
Some include:

• Salar de Uyuni: the largest salt deposit in the world (Pic.1)

Pic 1: Salar de Uyuni excursion in 2016

• Lake Titicaca: highest navigable body of water in the world (Pic. 2)

Pic 2: Lago Titicaca in Copacabana

• A country with the highest capital: La Paz’s altitude  is ~3,600 meters (~12,000 feet) above sea level 
• Mi Teleferico: longest and highest urban cable car network (Pics 3-10)

Pic 3: On the Orange line feat. Illimani       Pic 4: View of the city from the Orange line 

Among the many interesting attractions, we are going to focus on crossing the air space of La Paz city on Mi Teleférico while enjoying a magnificent view of the city. Mi Teleférico is a public system of transportation used by local people to overcome both the often jammed traffic and the steep streets of the city. It consists of 26 stations and includes 10 lines: Red, Yellow, Green, Blue, Orange, White, Light Blue, Purple,  Brown and Silver. As shown in my pictures, you get to see a big portion of the city on any color line. Which really caught my eye when I got on my first ride back in 2016. Not only do you get to your destination faster, you get to enjoy the view of the city. 

Pic 5: In city on the White line     Pic 6: Ground view of the Silver line 

 

If you are like me, you might be wondering how this type of machine works? How can it hold a car full with passengers up in the air without falling? Gondola lift is a type of transport that is mainly supported by cables in a continuous system. What is a continuous system you ask? Great question, to my understanding it is a system that runs smoothly with no delay, a continuous relay of cable cars from station to station. The cable cars rely on the cable rope because the cable car itself has no sort of power, like an engine. The system is passed through a drive bullwheel and returning bullwheel which the car’s cable is attached to. What I didn’t know is that there are different grip installations on the cable, the fixed grip and the detachable grip. As they are named, the fixed grip is permanently attached to the cable as both the wheels turn. On the other hand, the detachable grip detaches the cable from the car letting passengers enter and exit at a reasonable time 

Pic 7: Red Central Station feat. Illimani  Pic 8: Close up of a cable car feat. Illimani 

 

Pic 9: On the Purple line heading to the Pic 10. Purple Line going up to its station

 

References:

1. Altitude Sickness Bolivia & Peru: How to prevent it – bolivia hop. Bolivia Hop. (2021). Retrieved September 20, 2022, from https://www.boliviahop.com/altitude-sickness-peru-bolivia/ 
2. 3D Living Studio. (2022, January 7). How Cable Cars Work and Detach From The Cable [Video]. YouTube. https://www.youtube.com/watch?v=i2gxfB1aW48&ab_channel=3DLivingStudio 
3. Hinson, T. (2015, February 10). 10 of the world’s Best Cable Car Rides. CNN. Retrieved September 20, 2022, from https://www.cnn.com/travel/article/worlds-most-amazing-cable-cars/index.html 
4. Lewis, R. (2021, July 13). 13 tantalizing Lake Titicaca facts to know. Rainforest Cruises. Retrieved September 26, 2022, from https://www.rainforestcruises.com/guides/lake-titicaca-facts#:~:text=It%20is%20world%2Drecord%20breaking,and%20Bolivia%20to%20the%20east 
5. Unger, E. (2021, May 3). These salt flats are one of the most remarkable vistas on Earth. Travel. Retrieved September 20, 2022, from https://www.nationalgeographic.com/travel/article/how-to-see-salar-de-uyuni-salt-flats-bolivia#:~:text=Plan%20your%20trip%20with%20these%20tips.&text=Bolivia%27s%20Salar%20de%20Uyuni,prehistoric%20lakes%20evaporated%20long%20ago 

If you think of science fiction, you might think of Victor Frankenstein. Originally from Mary Shelley’s book Frankenstein, the creature and its lore has been modified over the centuries, but the general idea has remained quite the same. The story follows an ambitious student of natural sciences, Victor Frankenstein, who creates artificial life from pieces of corpses. Now, most people assume the creature is named Frankenstein, although that is the name of the scientist who created it and the monster itself is just known as Frankenstein’s monster. When you think of the monster, you probably imagine some stitched up humanoid creature, with nuts and bolts and different colored body parts, pale gray or even a light blue/green shade. But you get the idea: it’s a creature composed of body parts from several different corpses. What if I told you that there is an actual science relating to what Frankenstein did? It’s not exactly creating artificial life from human body parts, but it’s transplanting living cells, tissue, or even organs from one species to another. While it sounds like a concept straight out of a science fiction novel, it is in fact a real scientific concept that has been used in the past and present, and it is known as xenotransplantation. 

Why is this even a concept? Frankly, it sounds impossible. But it is an important subject, and it is a very heavily debated one. In the USA currently, there is a long list of patients waiting to receive an organ transplant. There aren’t enough organ donors to meet the demand, and as a result, 17 people die daily waiting for a transplant. When there’s such a shortage of donors, we need to turn to science to help us find a solution. One proposed solution has been xenotransplantation, which is not a new concept in medicine, but very heavily debated, and hasn’t had much success proving itself as a viable option. The biggest concern with xenotransplantation right now is success. Every trial of it has ended in the death of the patient, largely due to infections and complications with the body accepting a foreign organ. The first recorded case of heart xenotransplantation was in 1964, when Dr. James Hardy transplanted a chimpanzee heart into a semi-comatose patient experiencing a vascular disease. The transplant was only successful for a couple of hours, before the patient passed away due to the chimpanzee heart not being large enough to support the blood circulation. 

Potential animal donors include pigs, chimpanzees, and baboons; primates being the most common due to their compatibility with humans. Currently, there is a lot of research going into genetically modifying these organs to be compatible with the human body. A more recent case of xenotransplantation was a kidney transplant in September of 2021. While the donor recipient was technically deceased and placed on a ventilator, the point of the transplant was to study the function of the kidney and watch for signs of rejection. In this case, the kidney was a genetically modified pig kidney. Throughout the period of study, which lasted 54 hours, no signs of rejection were detected and key indicators of a properly functioning kidney were present. This is a huge step towards the implementation of xenotransplantation in the future, but much more research remains to be done. 

Ethical concerns are also brought up in discussion of xenotransplantation. There is a public health risk associated with cross-species transplantation; we do not know how interactions with the donor recipient and the general public will go and if there is risk of disease transmission. Therefore, the question is brought up: can we allow xenotransplantation if it will affect people outside the recipient and how do we gauge that level of consent? Aside from public health, animal rights are also brought into question. Animals cannot speak for themselves and therefore do not have a say in what happens to them. Is it ethical to use animals like chimpanzees and pigs solely for their organs, and if not, what makes it different from raising animals to kill them for their meat? Is killing a primate more serious than killing a pig due to its proximity to humans? What actually lets us determine if it is or isn’t ethical to raise and kill animals for the purpose of using their organs? What are our limits, as human beings? These are only a couple of questions raised when debating the ethics of xenotransplantation. 

Until the risk of transmission of animal pathogens is eradicated, and researchers actually find a way for cross-species transplants to be successful, xenotransplantation remains out of the question as a solution to the organ donor shortage. We cannot think of xenotransplantation until we make a medical breakthrough that would allow it to be a success, and have recorded success. The ethical debates surrounding it also can only be considered when progress is made. Regardless of the chance of success, it is still an interesting topic to think about. The implications of xenotransplantation affect subjects just beyond organ donors; cross-species medicine could be the future. While it isn’t the same science as Frankenstein, the intersection of science and science fiction is truly amazing to see. 

 

Sources: 

https://www.fda.gov/vaccines-blood-biologics/xenotransplantation 

https://www.organdonor.gov/learn/organ-donation-statistics 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246856/ 

https://nyulangone.org/news/progress-xenotransplantation-opens-door-new-supply-critically-needed-organs 

https://www.pbs.org/wgbh/pages/frontline/shows/organfarm/regulators/clark.html#:~:text=Ethical%20issues%20concerning%20xenotransplantation%20include,given%20the%20public%20health%20risks 

Yeah, I got my brain scanned for science. And you should too! (If you’re eligible, that is.)

Basically, I got an MRI scan of my brain done recently as part of a study at the GT/GSU Center for Advanced Brain Imaging (CABI). And while I was kind of nervous about the process, I wanted to write about the experience to help other people. If you’re about to get an MRI scan for medical reasons or for a study, I hope this article can relieve any fears or answer any questions you might have!

So, what is an MRI? MRI stands for Magnetic Resonance Imaging. An MRI machine looks like a very large tube with a donut sized hole on the end. During an MRI, you lay down in front of the donut and the technician moves you into the machine. By using magnets, the machine is able to take 3D images of your organs (in my case, my brain!). Since an MRI is so detailed and there’s no radiation risk, it is often used by doctors to detect tumors and look at brain injuries. There’s a version of an MRI called an fMRI, which shows which areas of your brain are activated. The f in fMRI stands for function, and fMRI images are able to help scientists understand how we think.

Since an MRI uses a really powerful magnet, you can’t bring anything metal in there. So, people with pacemakers, metal stents, braces, etc. might not be able to get an MRI. And when I say a powerful magnet, I mean it. The MRI machine at CABI is behind a heavy, access locked door with two large signs looking like the one on the right:

And if you have a morbid curiosity as to what would happen if you did bring in metal on or in you, check out this video: MRI vs Metal Coins (American Currency) DO NOT ATTEMPT To Replicate. Notice that just by being near the MRI, the camera goes all wonky. Some other metal things that you might not consider:

• Some tattoo inks that include metal
• Earrings
• Hearing implants
• Magnetic eyelashes
• Those metal fasteners on pants

If you have any of these, it doesn’t mean you’re automatically disqualified from getting an MRI, but it’s important to bring it up to the technician or radiologist.

After I made sure I was metal free, I stepped into the MRI control room. There was a giant window where the researchers and technician would be able to see me laying in the MRI in the next room. I took off my jacket and shoes, feeling a bit jittery now. I was going to be INSIDE that giant thing.

The research assistant made her way over to me with a Vitamin E capsule and some tape. At my confused look, she explained, “Vitamin E shows up really brightly on the MRI, so we are gonna put this on your left forehead. That way, when the scans come in, we can tell which side is the left.” Makes sense to me. But that didn’t make it feel less weird when I put it on my head.

The technician led me into the MRI room, where I laid down on the extended platform. It felt like the kind of examination table they have at the doctor’s office, but it was more padded. That was to discourage people from moving around and messing up the scan. After I laid down, I felt the technician place down more padding around my head and feet. She also gave me earplugs and a bulb that I was supposed to squeeze if I needed anything once I was in the machine. As she did all this and wheeled me into the darkness of the machine, she told me what she was doing. This helped calm my nerves a lot, considering I couldn’t see what was going on. 

Finally, the technician turned the machine on, and I immediately appreciated the earplugs. The beeping reminded me of an alarm clock. I heard that some people can fall asleep during an MRI, but that wasn’t me. It wasn’t earsplitting, but just loud enough that it never faded into the background.

My earplugs were attached to an earpiece. After a burst of static, I heard the research assistant over the beeps. 

“Okay, we’re going to do the first part of the MRI and take a picture of your brain’s structure. Do you feel okay?”

I nodded. There was a pause. “Wait, sorry,” I said, smiling sheepishly to myself in the dark of the machine. Obviously, they couldn’t see me. “Yes, I’m all ready.”

The actual imaging itself was boring, but I passed the time imagining the magnetic beam hitting all of my cells. After a while, I could almost feel the beam on my skin. There wasn’t actually anything, of course. Then, the fMRI was done. The beeping was a different rhythm–more pleasant, in my opinion.

While the scan was being performed, I completed a memory task as part of the study. A screen was put in front of me while I was still in the scanner, with the image projected from a computer screen in the control room using some mirrors. Using a control pad of buttons, I was even able to manipulate what was on the screen. I didn’t even know you could do all that while in an MRI machine!

Soon, I was able to be released from the dark void I had been in previously. The whole process took around half an hour–much shorter than I expected. Other than some numbness from staying as still as possible, I felt alright. And I was excited to see what my brain really looked like!

And there it was–all of my consciousness, my memories, my thoughts, my emotions, dreams, fears all up on that screen. It looked so complicated and fragile and beautiful. As a neuroscience major, I saw pictures of brains every day. But nothing hits quite like seeing your own brain up there in black and white. And there I was, using my brain to understand that what I saw in front of me was itself. It’s such an indescribable feeling!

And that reason, beyond just the contributions to science, is why I recommend getting an MRI done as part of a study. After this experience, I felt myself thinking about my own brain with more affection. This squishy, bumpy organ is me, and I should treat it with the study and love that it deserves.

 

References

https://www.researchgate.net/figure/Magnetic-field-warning-sign_fig1_345758192