Analysis of physician recipients of recognition awards from the American Academy of Physical Medicine and Rehabilitation by Race and Ethnicity.

BACKGROUND: Medical society recognition awards are important resources for physicians in advancing their careers. There is a need to better understand the representation of physician recipients by race and ethnicity, especially in women with intersectional identities. OBJECTIVE: To assess the proportions of American Academy of Physical Medicine and Rehabilitation (AAPM&R) award recipients by race and ethnicity and the intersection of gender. DESIGN: Cross-sectional and retrospective study. SETTING AND METHODS: One hundred seven (n = 107) published online physician award recipients from 2011 to 2020 were categorized by race, ethnicity, and gender by two independent researchers. There was 100% interrater agreement on race and gender and 95% on ethnicity. Data were analyzed with descriptive analysis and multilinear regression. MAIN OUTCOME MEASUREMENTS: Awards given to physicians coded by race (White/Caucasian, Asian, and Black/African American), ethnicity (Hispanic/Latino), and the intersection of gender with race and ethnicity were analyzed. The primary comparator was proportions by race, ethnicity, and gender of academic physicians in physical medicine and rehabilitation (PM&R) using Association of American Medical Colleges (AAMC) data. A secondary aim was recipients' proportions compared to AAMC benchmarks for all practicing physiatrists. RESULTS: There were no significant differences in representation of award recipients by race or ethnicity compared to the primary comparator of their percentages in academic PM&R. Notably, 96.3% of awards were given to physicians identified as being in or having been in academic medicine. Secondary analysis of award recipients to all practicing physiatrists revealed significant underrepresentation of recipients who were coded as (1) White/Caucasian women, Asian men and women, Black/African American men and women (p = .016), and (2) Hispanic/Latino men and women (p = .028). CONCLUSIONS: This is a novel study assessing race and ethnicity in physician recognition awards presented by a medical society. No significant disparities were found among recipients as compared to representation in academic PM&R. However, there were significant disparities when compared to all practicing physiatrists. These findings deserve further investigation and consideration as medical societies strive to equitably support all members.

Shoulder Ablation Approaches.

The shoulder is structurally and functionally complex. Shoulder pain may be refractory to conventional treatments, such as physical therapy, pharmacotherapy, and corticosteroid injections. In such cases, radiofrequency ablation may serve as an alternative treatment plan. Current literature has demonstrated 4 target nerves for ablative therapy: the suprascapular nerve, axillary nerve, lateral pectoral nerve, and subscapular nerve. Special caution is needed when targeting these nerves in order to avoid motor denervation. This article summarizes the current evidence for radiofrequency ablation as a useful treatment option for chronic shoulder pain as well as the described techniques for performing this promising procedure.

Joint and Back Pain: Medications and Role of Injection Therapy for Destructive Joint.

Postpolio syndrome (PPS) is a sequela with symptoms that often occur in patients who previously survived poliomyelitis. Pain is a characteristic feature of PPS. Although poliomyelitis is no longer commonly seen in the western world, there is a significant portion of patients living with PPS. Recognizing the signs of PPS is integral in developing treatment plans. Conservative management is routinely considered first-line therapy; however, alternate treatments, pharmacologic and minimally invasive, are used in more refractory cases. Approaching patients living with pain and PPS requires a holistic approach and an understanding of the efficacy of available treatment modalities.

Constitutive and induced activation of JAK/Stat pathway in leukemogenic and asymptomatic human T-cell lymphoptropic virus type 1 (HTLV-1) transformed rabbit cell lines.

We have shown that Vav and C-cbl are activated in the leukemogenic HTLV-I transformed rabbit T cell line RH/K34 but not in the asymptomatic one RH/K30. We extended these observations and investigated the activation of JAKs (Janus Kinase) and the STATs (signal transducers and activators of transcription) pathway in these cell lines. We found that Tyk2 and Stat3 are constitutively tyrosine phosphorylated in the leukemogenic cell line. Phosphorylation of Tyk2 can be induced in RH/K30 by treatment with IL-10, interferon alpha (INFalpha) and by the supernatant of RH/K34 which contain both these cytokines. Stat3 tyrosine phosphorylation can be induced in RH/K30 by treatment with IL-10. Transfection of RL-5, a rabbit T-cell line, with the RH/K34 viral clone transiently increased the expression of serine/threonine phosphorylated Stat3. Differences were also observed on induced Stat5 phosphorylation. These results highlight the relation between the virulence of HTLV-I and the activation of the Jak/Stat pathway.

A point mutation in the groove of HLA-DO allows egress from the endoplasmic reticulum independent of HLA-DM.

B lymphocytes express the nonclassical class II molecule HLA-DO, which modulates the peptide loading activity of HLA-DM in the endocytic pathway. Binding to HLA-DM is required for HLA-DO to egress from the endoplasmic reticulum (ER). To gain insights into the mode of action of DO and on the role of DM in ER release, we sought to identify DM-binding residues on DO. Our results show that DOalpha encompasses the binding site for HLA-DM. More specifically, mutation of residue DOalpha41 on an exposed lateral loop of the alpha1 domain affects the binding to DM, ER egress, and activity of DO. Using a series of chimeric DR/DO molecules, we confirmed the role of the alpha chain and established that a second DM-binding region is located C-terminal to the DOalpha80 residue, most probably in the alpha2 domain. Interestingly, after mutation of a buried proline (alpha11) on the floor of the putative peptide-binding groove, HLA-DO remained functional but became independent of HLA-DM for ER egress and intracellular trafficking. Collectively, these results suggest that the binding of HLA-DM to DOalpha allows the complex to egress from the ER by stabilizing intramolecular contacts between the N-terminal antiparallel beta-strands of the DOalphabeta heterodimer.

Functional analysis of tryptophans alpha 62 and beta 120 on HLA-DM.

In the endocytic pathway of antigen-presenting cells, HLA-DM catalyzes the exchange between class II-associated invariant chain peptide (CLIP) and antigenic peptides onto major histocompatibility complex class II molecules. At low pH of lysosomal compartments, both HLA-DM and HLA-DR undergo conformational changes, and it was recently postulated that two partially exposed tryptophans on HLA-DM might be involved in the interaction between the two molecules. To define contact regions on HLA-DM, we have conducted site-directed mutagenesis on those two hydrophobic residues. The HLA-DM alphaW62A,betaW120A (DM(W62A/W120A)) double mutant was expressed in HLA-DR(+) HeLa cells expressing invariant chain, and the activity of this DM molecule was assessed. Flow cytometry analysis of cell surface DR-CLIP complexes revealed that DM(W62A/W120A) removes CLIP as efficiently as its wild-type counterpart. DM(W62A/W120A) was found in the endocytic pathway by immunofluorescence, and DM-DR complexes were immunoprecipitated from these cells at pH 5. Finally, mutations alphaW62A and betaW120A on HLA-DM did not affect the association with HLA-DO. The complex egresses the endoplasmic reticulum and accumulates in endocytic vesicles. Moreover, DO and DM(W62A/)W120A were co-immunoprecipitated at pH 7. We conclude that the alpha62 and beta120 tryptophan residues are not required for the activity of DM, nor are they directly implicated in the interaction with DR or DO.