Similar to other reports in medical subspecialties, non-randomized studies provided results dissimilar to randomized trials of arthroplasty vs internal fixation for mortality and revision rates in patients with femoral neck fractures. Investigators should be aware of these discrepancies when evaluating the merits of alternative surgical interventions, especially when both randomized trials and non-randomized comparative studies are available.

Many acute COVID-19 convalescents experience a persistent sequelae of infection, called post-acute COVID-19 syndrome (PACS). With incidence ranging between 31% and 69%, PACS is becoming increasingly acknowledged as a new disease state in the context of SARS-CoV-2 infection. As SARS-CoV-2 infection can affect several organ systems to varying degrees and durations, the cellular and molecular abnormalities contributing to PACS pathogenesis remain unclear. Despite our limited understanding of how SARS-CoV-2 infection promotes this persistent disease state, mitochondrial dysfunction has been increasingly recognized as a contributing factor to acute SARS-CoV-2 infection and, more recently, to PACS pathogenesis. The biological mechanisms contributing to this phenomena have not been well established in previous literature; however, in this review, we summarize the evidence that NAD+ metabolome disruption and subsequent mitochondrial dysfunction following SARS-CoV-2 genome integration may contribute to PACS biological pathogenesis. We also briefly examine the coordinated and complex relationship between increased oxidative stress, inflammation, and mitochondrial dysfunction and speculate as to how SARS-CoV-2-mediated NAD+ depletion may be causing these abnormalities in PACS. As such, we present evidence supporting the therapeutic potential of intravenous administration of NAD+ as a novel treatment intervention for PACS symptom management.

Emerging evidence promotes stellate ganglion blocks (SGB) as a treatment for post-traumatic stress disorder (PTSD) in individuals who have not fully responded to conventional therapies. Ongoing research aims to assess the reliability and sustainability of this intervention. A 36-year-old female presented to our clinic complaining of severe and persistent symptoms since childhood, consistent with a diagnosis of PTSD and trauma-induced anxiety. The patient tried traditional psychological therapies and psychotropic medications for multiple years without optimal symptom relief. The patient underwent two sets of bilateral SGB: one set of standard injections performed with 0.5% bupivacaine and one set performed with the addition of botulinum toxin (Botox) injected into the stellate ganglion. After the initial standard bilateral SGB procedures, the patient experienced a significant reduction in PTSD symptoms. Two months later, however, the somatic symptoms of PTSD and trauma-induced anxiety returned, including hypervigilance, nightmares, insomnia, hyperhidrosis, and muscle tension. The patient elected to proceed with a set of Botox-enhanced SGB, and the results demonstrated profound relief as quantified by a drop in PTSD Checklist Version 5 (PCL-5) scores from 57 to 2. At a six-month follow-up since the initial injections, the patient reported significant and sustained relief from her PTSD symptoms. We report that the addition of Botox in a selective blockade of the stellate ganglion reduced our patient's PTSD symptoms to below the PTSD diagnostic threshold for a sustained period while providing additional benefits of reduced anxiety, hyperhidrosis, and pain. We provide a reasonable explanation for our findings.

This One month safety study addresses any potential risks behind the use of bone marrow-derived mesenchymal stem cell extracellular vesicle isolate product (ExoFlo Direct Biologics) as a treatment for cervical and lumbar radiculopathy. Ten healthy adults were treated with ExoFlo injections for cervical radiculopathy (n=5) and lumbar radiculopathy (n=5). Follow up occurred twenty-four hours, three days, one week, three weeks and one month post injection. By the one month follow-up, the average patient improved 55% in BPI, 55.2% in QD, 25.4% in UEFS, 19.75% in ODI and 26% in LEFS. There were no complications or adverse events by the end of the study and no patient exhibited worsening radiculopathy. Patients will continue to be followed for at least six months post injection.