Dee H. Wu

This review focuses on musculoskeletal disorders (MSDs), which are a frequent occupational hazard among surgeons, with prevalence rates exceeding 70-90% across specialties. Common symptoms include neck, back, and shoulder pain, as well as generalized fatigue, particularly among those performing laparoscopic and robotic procedures. Key risk factors include static posture, repetitive motion, and prolonged procedural duration. Female surgeons also were cited to face elevated MSD risk due to equipment design mismatches and physiological factors, while residents report higher pain levels than attendings, often linked to workload and limited ergonomic training. The surgical environment plays a critical role in MSD development. Poor ergonomics in the operating room include issues such as suboptimal table height and instrument design, which exacerbate physical strain. Although robotic surgery improves posture, it does not eliminate discomfort, and endoscopic approaches impose unique demands. Mitigation strategies include ergonomic training, optimized posture and table height, redesigned instruments, and supportive hardware such as ergonomic chairs. Behavioral interventions such as microbreaks, ambidexterity training, and stretching have shown promise in enhancing endurance and reducing fatigue. Importantly, for surgeons, MSDs contribute to early retirement, burnout, and workforce shortages. This paper advocates for a paradigm shift: viewing surgeon fatigue not as a personal failure but because of system design. Based on this review, we suggest that integrating ergonomics into surgical education, operating room design, and health policy could be vital for maintaining surgeon well-being and health care quality.

Brain metastases are a common and deadly complication of many primary tumors. The progression of these tumors is poorly understood, and treatment options are limited. Two important components of tumor growth are hypoxia and angiogenesis. We conducted a review to look at the possibility of a symbiotic relationship between two transcription factors, Hypoxia-Inducible Factor 1α (HIF1α) and Vascular Endothelial Growth Factor (VEGF), and the role they play in metastasis to the brain. We delve further into this possible relationship by examining commonly used chemotherapeutic agents and their targets. Through an extensive literature review, we identified articles that provided evidence of a strong connection between these transcription factors and the growth of brain metastases, many highlighting a symbiotic relationship. Further supporting this, combinations of chemotherapeutic drugs with varying targets have increased the efficacy of treatment. Angiogenesis and hypoxia have long been known to play a large role in the invasion, growth, and poor outcomes of tumors. However, it is not fully understood how these factors influence one another during metastases. While prior studies have investigated the effects separately, we specifically delve into the synergistic and compounding effects that may exist between them. Our findings underscore the need for greater research allocation to investigate the possible symbiotic relationship between angiogenesis and hypoxia in brain metastasis.

Brain metastases are a common and deadly complication of many primary tumors. The progression of these tumors is poorly understood, and treatment options are limited. Two important components of tumor growth are hypoxia and angiogenesis. We conducted a review to look at the possibility of a symbiotic relationship between two transcription factors, Hypoxia Inducible Factor 1α and Vascular Endothelial Growth Factor, and the role they play in metastasis to the brain. We delve further into this possible relationship by examining commonly used chemotherapeutic agents and their targets. Through extensive literature review, we identified articles that provided evidence of a strong connection between these transcription factors and the growth of brain metastases, many highlighting a symbiotic relationship. Further supporting this, combinations of chemotherapeutic drugs with varying targets have increased the efficacy of treatment. Angiogenesis and hypoxia have long been known to play a large role in the invasion, growth, and poor outcomes of tumors. However, it is not fully understood how these factors influence one another during metastases. While prior studies have investigated the effects separately, we specifically delve into the synergistic and compounding effects that may exist between them. Our findings underscore the need for greater research allocation to investigate the possible symbiotic relationship between angiogenesis and hypoxia in brain metastasis.

Background/Objectives: The accurate detection of microcalcifications in mammograms is critical for the early detection of breast cancer. However, the variability between different manufacturers is significant, particularly with digital breast tomosynthesis (DBT). Manufacturers have many design differences, including sweep angles, detector types, reconstruction techniques, filters, and focal spot construction. This study outlined the development of an innovative phantom model using crystallizations to improve the accuracy of imaging microcalcifications in DBT. The goal of these models was to achieve consistent evaluations, thereby reducing the variability between different scanners. Methods: We created a novel phantom model that simulates different types of breast tissue densities with calcifications. Furthermore, these crystalline-grown phantoms can more accurately represent the physiological shapes and compositions of microcalcifications than do other available phantoms for calcifications and can be evaluated on different systems. Microcalcification patterns were generated using the evaporation of sodium chloride, transplantation of calcium carbonate crystals, and/or injection of hydroxyapatite. These patterns were embedded in multiple layers within the wax to simulate various depths and distributions of calcifications with the ability to generate a large variety of patterns. Results: The tomosynthesis imaging revealed phantoms that utilized calcium carbonate crystals showed demonstrable visualization differences between the 3D DBT reconstructions and the magnification/2D view, illustrating the model’s value. The phantom was able to highlight changes in the contrast and resolution, which is crucial for accurate microcalcification evaluation. Conclusions: Based on the crystalline growth, this phantom model offers an important new standardized target for evaluating DBT systems. By promoting standardization, especially through the development of advanced breast calcification phantoms, this work and design aimed to contribute to improving earlier and more accurate breast cancer detection.

Background: The literature on the relationships among blood iron levels, cognitive performance, and brain iron levels specific to women at the menopausal transition is ambiguous at best. The need to better understand these potential relationships in women for whom monthly blood loss (and thus iron loss) is ceasing is highlighted by iron’s accumulation in brain tissue over time, thought to be a factor in the development of neurodegenerative disease. Methods: Non-anemic women who were either low in iron or had normal iron levels for their age and race/ethnicity provided blood samples, underwent MRI scans to estimate brain iron levels, and performed a set of cognitive tasks with concurrent EEG. Results: Cognitive performance and brain dynamics were positively related to iron levels, including measures associated with oxygen transport. There were no relationships between any of the blood measures of iron and brain iron. Conclusions: Higher iron status was associated with better cognitive performance in a sample of women who were neither iron deficient nor anemic, without there being any indication that higher levels of systemic iron were related to higher levels of brain iron. Consequently, addressing low iron levels at the menopausal transition may be a candidate approach for alleviating the “brain fog” commonly experienced at menopause.

Background The literature on the relationships among blood iron levels, cognitive performance, and brain iron levels specific to women at the menopausal transition is ambiguous at best. The need to better to understand these potential relationships in women for whom monthly blood loss (and thus iron loss) is ceasing is highlighted by the fact that iron accumulates in brain tissue over time and that accumulation is thought to be a factor in the development of neurodegenerative disease. Methods Non-anemic women who were either low in iron or had normal iron levels for their age and race/ethnicity provided blood samples, underwent MRI scans to estimate brain iron levels, and performed a set of cognitive tasks with concurrent EEG. Results: Cognitive performance as well as brain dynamics were positively related to iron levels, including measures associated with oxygen transport. There were no relationships between any of the blood measures of iron and brain iron. Conclusions Higher iron status was associated with better cognitive performance in a sample of women who were neither iron deficient nor anemic, without there being any indication that higher levels of systemic iron were related to higher levels of brain. Consequently, addressing low iron levels at the menopausal transition may be a candidate approach for alleviating the “brain fog” commonly experienced at menopause.

Background/Objectives: Accurate detection of microcalcifications in mammograms is critical for the early detection of breast cancer. However, variability between different manufacturers is significant, particularly with digital breast tomosynthesis (DBT). Manufacturers have many design differences, including sweep angles, detector types, reconstruction techniques, filters, and focal spot size. This study describes developing a novel phantom model based on crystallizations to standardize microcalcification detection in DBT, aiming to create consistency in the evaluation, which can lead to inconsistent interpretations and patient management. Methods: We created a novel phantom model that simulates different types of breast tissue density with calcifications. Further, these crystalline-grown phantoms can more accurately represent microcalcification’s physiological shapes and compositions than other available phantoms for calcifications and can be evaluated on different systems. Microcalcification patterns were generated using evaporation of sodium chloride, transplantation of calcium carbonate crystals, and/or injection of hydroxyapatite. These patterns were embedded in multiple layers within the wax to simulate various depths and distributions of calcifications with the ability to generate a large variety of patterns. Results: Tomosynthesis imaging revealed that phantoms utilizing calcium carbonate crystals showed demonstrable visualization differences between the 3D DBT reconstructions and the magnification/2D view, illustrating the model's value. The phantom was able to highlight changes in contrast and resolution, which is crucial for accurate microcalcification evaluation. Conclusions: Based on crystalline growth, this phantom model offers an important new standardized target for evaluating DBT systems. By promoting standardization, especially through the development of advanced breast calcification phantoms, this work and design aims to contribute to improving earlier and more accurate breast cancer detection.

Alzheimer’s disease (AD), affecting nearly 6.5 million people, is the fifth leading cause of death in individuals 65 years or older in the USA. Prior research has shown that AD disproportionality affects females; females have a greater incidence rate, perform worse on a variety of neuropsychological tasks, and have greater total brain atrophy. Recent research has linked these sex differences to neuroimaging markers of brain pathology, such as hippocampal volumes. Specifically, research from our lab found that functional connectivity from the hippocampus to the precuneus cortex and brain stem was significantly stronger in males than in females with mild cognitive impairment. The aim of this study was to extend our understanding to individuals with AD and to determine if these potential sex-specific functional connectivity biomarkers extend through different disease stages. The resting state fMRI and T2 MRI of cognitively normal individuals (n = 32, female = 16) and individuals with AD (n = 32, female = 16) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) were analyzed using the Functional Connectivity Toolbox (CONN). Our results demonstrate that males had a significantly stronger interhemispheric functional connectivity between the left and right hippocampus compared to females. These results improve our current understanding of the role of the hippocampus in sex differences in AD. Understanding the contribution of impaired functional connectivity sex differences may aid in the development of sex-specific precision medicine for improved AD treatment.