Thursday, April 25, 2013

DNA Structure Discovered 60 Years Ago

One of the world's most important scientific papers was published in the journal Nature on April 25, 1953, 60 years ago today.  The entire paper was just one page!  In the short communication, James Watson and Francis Crick not only detailed the definitive structure of DNA (deoxyribonucleic acid)  but also proposed the unzipping mechanism by which the molecule could replicate itself.  They initially announced they had found "the secret of life" at the Eagle Pub in Cambridge, England.    (See the DNA diagram from the actual paper to the right)

These two brilliant men figured out the chemical structure of DNA without doing any experiments.  They started by carefully digested and then synthesizing the world's literature.  They attended conferences and sought data anywhere they could find it.  They were ridiculed for building stick models instead of conducting costly and time consuming lab investigations.  The solution to the beautiful double helix structure of DNA arose via the collaboration of biologist Watson and physicist Crick.  Neither one of them had an elite understanding of chemistry.  They even challenged and eventually proved wrong the triple helix structure proposed by famous chemist Linus Pauling.  

Sixty years later, their discovery and the subsequent research on recombinant DNA and genomic sequencing has transformed our lives.  Today, we take for granted our ability to "grow" human insulin in bioreactors and target specific cancers with molecular designer drugs.  It is appropriate to pause for just a moment today and thank the two dreamers who via their hard work and intuition discovered the structure of DNA.  Let's hope we can find and encourage many more dreamers like Watson and Crick.

References:  Watson and Crick,  Nature April 1953

Saturday, April 13, 2013

Kobe Bryant Tears Achilles Tendon

Kobe Bryant last night in made a cut on the basketball court he has made a million times and felt like "somebody kicked" him.  He unfortunately sustained an achilles tendon tear.   See the video below of the injury:

He will likely have surgery in the near future.  The surgical takes about an hour.  Rehabilitation typically takes anywhere from 9-12 months.  Some surgeons are augmenting achilles repairs with platelet-rich plasma pointing to anecdotal evidence suggesting PRP could accelerate recovery.

Here is a video of how to clinically diagnosis an achilles tendon tear:

Below are some pictures that outline the steps in an Achilles tendon repair  
Torn tendon, suture repair, closure
If anyone can come back from this injury, Kobe can.  The NBA and all of basketball are wishing him the the best for his surgery if needed and for his full recovery.


Tuesday, April 02, 2013

Compound Tibia Fractures, Kevin Ware NCAA hoops

You may have heard about the nasty compound shin bone fracture sustained by Louisville's Kevin Ware in the NCAA Regional Final game on Sunday.  These fractures are also known as open tibia fractures.  In this post, I'll outline some of the details of this serious injury to help everyone understand it better.

For a compound or open fracture to occur without any contact is very rare.  I did a search on PubMed yesterday and couldn't find even a case report of one.  So, we need to try to better understand why his shin bone or tibia failed.  Is it because he jumped and then landed with a dramatic twisting force?  That is one possibility.  Another one is that he may have had some underlying weakness of his bone prior to the injury.  It occurred to me that these young men play a ton of hoops especially toward the end of the year with their conference tournaments and then immediately thereafter they participate in the NCAA tourney.  Did he have some stress injury to the bone due to playing so many games that may have predisposed it to failure?  Is it possible that he had a metabolic bone problem that resulted in it being weak?  Finally, was it simply one of worst cases of bad luck in a basketball history?  We may never know.

It is crucial that he was treated immediately by an elite trauma team.  Indy has some of the best in the country.  What he likely had to have done was a wash out of the area where the bone poked through the skin and then an insertion of a titanium nail to stabilize the bone.  He also sustained injuries to the skin and muscle around the bone.  These are known as soft tissue injuries.  These will also need to heal.  In addition to the surgery, he was likely given intravenous antibiotics to help prevent the onset of infection.

Mr. Ware's type of fracture usually takes several months to heal properly.  Occasionally, additional growth factors are given at the time of surgery to improve the chances the fracture consolidates.  Or, external devices that deliver ultrasound or electrical stimulation are used to enhance or accelerate the bone healing.  Even if everything initially is done perfectly as it seems to have been in this case, there is still a risk of bone not healing (delayed or non-union) or the possibility of late infection.

It is great to see Mr. Ware up and sending out pictures.  This young man dealt with a severe injury that was witnessed by millions of people on live TV with incredible courage and poise.  Hopefully his recovery will be uneventful and speedy.  I know we all would love to see him back on the court as soon as possible.


View an excellent story about the injury from Dr. Jon LaPook and Scott Pelley from the CBS Evening News.

Melvin et al.  “Open Tibial Shaft Fractures:  I.  Evaluation and Initial Wound Management”
Journal of the American Academy of Orthopeadic Surgeons

Melvin et al.  “Open Tibial Shaft Fractures: II.  Definitive Management and Limb Salvage”
Journal of the American Academy of Orthopeadic Surgeons

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