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... Cardiac and Vascular Complications of COVID-19: A Review Aaron Schmid1, Marija Petrovic1, Kavya Akella1, Anisha Pareddy1, Sumathilatha Sakthi Velavan 1 1 Division of Biomedical Sciences, Marian University College of Osteopathic Medicine Indianapolis, IN Pathogenesis of COVID-19 Cardiovascular Disease and Effects Cardiac Complications Six proposed mechanisms: Similar to COVID-19, myocarditis is often preceded by flu-like and gastrointestinal sympt oms (10) 46% of patients infected with COVID-19 with no known underlying cardiac disease had abnormal echocardiography findings (11)) Patients with later confirmed COVID-19 may initially present to the doctor because of cardiovascular symptoms such as heart palpitations and chest tightness (30,31) Arrhythmias Myocarditis 1. Angiotensin converting enzyme (ACE-2) receptor-dependent myocardial infection causing direct cardiac damage. (1) 2. Hypoxia-induced injury due to oxidative stress, acidosis, and mitochondrial damage. (1) 3. Inflammation resulting in vessel hyperpermeability and angiospasm, causing damage to the heart's microvasculature. (1) 4. Systemic inflammatory reaction and cytosine storm mediating damage The COVID-19 Patient 16.7% of COVI0-19 patients were seen with arrhythmias 'Mth 44.4% prevalence In those who were admitted to the ICU (18, 19) Arrhythmias could be due to myoeardltis, myocardial lschemla. 1nrecIJM-indi,ced hypoxla. fewir. metabolic disarray, honnonal dysregulation, medication {ox, azithromycin and hydroxychlotoquine COVID 19 ltf!lattnMlS), or inflamm.ation. (20. 21. 22. 23) Pati ents m ay also present w ith elevated cardiac biomartcers, myopericarditis, angina, chest pressure, ST-elevation, and systolic dysfunction without any signs or sympt oms of infection such as fever, cough, dyspnea, or respiratory involvement (32-34) Atrial fibrillation, ventricular dysfunction, and myocarditis are sequelae seen in COVI019 patients despite no evidence of prior CVO, CAO, HF, cancer, hypertension, or smoking Does the risk o f card iovascular d isease persist after COVI0-19 Infection? (1) ~;essel occlusion due to coagulopathy, thrombosis, embolus, plaque ( instability, or plaque rupture from system inflammatory response. (1) 6. Stress-induced cardiomyopathy and cardiac injury due to increases in catecholamines from a stress response in a patient. (1) cardiac Biomarkers Elevated troponin levels in C.OVID-19 patients were associated with elevated levels of CRP Vascular Complications -31% of patients with COVID-19 in the ICU had thrombotic complications despite thromboprophylaxis. These patients exhibited prolonged PT (prothrombin time) and aPTT (activated partial thromboplastin time) time(3). Stroke It is very important to screen high risk COVID-19 Concomitant venous and arterial thrombotic events Several studies showed the presence of venous and arterial thrombosis in a high percentage of COVID-19 patients, with suggestive lab values including elevated 0- dimer and elevated c-reactive protein (4,5) Coagulopathy patients that present w ith comorbidities especially Some COVID-19 patients present with a term known as COVID-19 associated coagulopathy (CAC), similar to DIC hypertension for the potential of stroke. (6) (disseminated intravascular coagulation). Studies have shown that important markers in high risk CAC differs from DIC in that it has: patients that may indicate stroke include: Elevated D-dimer, cardiac troponin T, prothrombin time, elevated fibrinogen levels, elevated c-reactive protein, and c-reactive protein l7). antiphospholipid antibodies (2,4, 7-9) activated complement, and presence of and NT proBNP, linking myocardial injury to severity of inflammation,. and w ere also associated with a more severe disease course and worse prognosis (12-15) Heart Failure Heart failure relat ed to ventricular dysfunction, myocarditis, acute coronary syndrome, arrythmia, p ulmonary hypertension, ARDS, and cardiomyopathy occurs in up to 23% of COVID-19 patients (16,17). 10-year follow-up study showed an increased risk of cardiovascular disease and t 'Cdiac Acute Coronary Syndrome Increased tlvombotic event risk can cause increased ACS risk in COVID-19 positive patients. (24) Myocardial irjury with ST-segment elevalion has been observed in positive patients in addition to reduced left ventrie

... BACKGROUND Multi-system disorders may be difficult to differentiate between, especially as genetic causes are still being defined and in light of phenotypic variability. We present a case of a teen with multiple congenital defects for which genetic testing was inconclusive, showing features of : Noonan Syndrome (NS), Mullerian duct aplasia-renal aplasia-cervicothoracic somite dysplasia (MURCS), and VACTERL association. Without definitive gene information, clinical features were used to consider diagnosis; this case presents an atypical patient presentation with features seen in NS, MURCS, and VACTERL association, as well as novel features not seen in any of those disorders. CASE PRESENTATION Clinical Features I Ca.rdiac Oral Facial Features Myxomatous mitral valve Cleft lip & palate, vetopharyngeal incomp. Slightly down slanting palpebral fissures , fullness to tip of nose, course features with square jaw and square facies Ears Full and fleshy, 6.2 cm bilaterally (15 th%) Endocrine Hypoplastic anterior pituitary hypothyroidism, dysmenorrhea Neurologlc/ ADHD-inattentive subtype, Anxiety, Development Average intelligence (FSIQ=92) Skeletal Head circumference > 97 th%, short neck & stature, sloping shoulders, congen ital scoliosis, hemivertebrae, butterfly vertebra, hydromyelia, spina bifida occulta Skin/Hair Thick curly hair, low posterior hairline, cafe au lait macules, 1 hypopigmented macule . Table 2, Phenotype Comparison of Key Genetic Disorders in the Differential, VACTERL Noonan Syndrome MURCS Unique Items Aaaoclatlon Key clinical Short stature, facial j Primary Vertebral defects, Myxomatous features deformities, congenital l amenorrhea, scoliosis, anal mijraJ valve, spina heart defects, scoliosis, genitourinary bifida occulta, atresia, cardiac thyroid dysfunction, defects, short defects, tracheo- dysmenorrhea, hyperelastic skin, thick stature, rib esophageal fistula, cafe au laits, curly hair or thin sparse anomalies, Sprengel renal anomalies, ligamentous laxity hair, low posterior deformities, limb abnormalities of fingers, flat hairline, webbed neck cervicothoracic footed vertebral defects, upper limb defects Other features Facial features .. Parents: Average height, healthy Medications: Past: stimulant trials, Growth hormone (-1315 years) Current: OCP, levothyroxine, atomoxetine, iron . Full Brother: delayed bone age & puberty Paternal Uncle: aortic dissection Maternal Cousins: hip dysplasia Genetic testing: . Microarray-negative Whole Exome- negative Hypertelorism, high Facial asymmetry, forehead, short neck, . micrognathia, relative rnacrocephaly, conductive hearing downslanting palpebral loss, cleft lip and i executive function deficits, autism spectrum .__ _ __,__ disorder ADHD Undefined i fissures ; Development Mild to average & Behavioral Intellectual functioning , I Genetic testing provides important information, but the field of genetics is still advancing and testing limitations remain . Clinical diagnosis of genetic disorders remains important. Patients benefit when ident,ified with genetic disorders (e.g. NS, MURCS, VACTERL), which drive medical care for treatment of known issues and monitoring of highly likely features. Clinicians should continue to track individuals with multiple congenital anomalies and have increased suspicion of a genetic disorder even when a clear diagnosis has not presented itself. Atypical and novel disorder presentations continue to arise . Hydromyella Coagulation defects, ocular abnormalities, dermatologic findings, *3Lz defects needed ~tic h;igi:.:roma ~ -- . + - - - - - - - . + --'fi,,,o._r,. ,1;,....,..,.,,.,,os,,,..,is,_*_-+-------' Pregnancy/ Birth History: Family History: Non-contributory DISCUSSION/CONCLUSIONS Figure 1. Clinical Features of Noonan Syndrome in child/adolescent Table 1. Patient Clinical Presentation. palate Undefined Undefined profile - - 1tems in bold represent overlapping clinical features found in our patient case. Fullness to tip of nose, course features with square jaw and square facies Anxiety REFERENCES 111 Clo H, ~,t JiYt N, KIHI OD, 1H iii, ,.,.\'ltW of cr&nlolaclll ana dtm&lflndil'IQI oi 1"11 RASot)lilNI, OtrMd Ctaniotac RH.. 2017;20 Suppl l(Suppl 1)::32:~3812] Covill N1.. KH&oan-Fullv D, Davenpon ML. 8111. Cklffl pal~ tltld hy~il.o.tllffl In a pt,111!"11 wiffi Noontflo!IM lyndf'OMOwllh 1oOMan1gal'lhtllr I. AmJMIGlf'I.WPl#IA. 2011: 17A:2024--2027. (3] Foli'tan.a l. ~--. B. Fedtlt I.. et Ill 0.Mtlce 01,.layer-Ro1diantky-KO:Uer-Haua., lW'\K'O syndrome, Clin Gen.,L 2017; 91: 233,-246. (-1] o.tg S, Bl'oob A. 8 1.11n. A.. Mat Au1llffi ~Kll'um ~rd IIAd olhlt neut0ti111M"AI.., :Mrbfold1tiea 1ft raie d li50fdel'll ot lhe Ra.s/MAPK pathway. Gell' MtJd CbJd N.Jrol. 2011; S9: 544-S-'B. IS] P-rrlno F, Ucchall A. S.rr G. 111111. Pyc:hopathologk:111 FHturn~Noonln SyndfCNM. EIKOPHll Jocim111 of P.fd,'11 tne:ffll!Jf0iogy. 2018: 21(1), 170- 111. IS] Pierpo,w; Me, Olglllo MC. Cafd.ay11C\fit dl1nu In Noonan yndrom. Cum.ti( Oplllilon.:i P-,r,Jcl. 2011:30(5),.01--408, (7J Robert& AE. Alanson J~ T111.1.gl!8 M. Golb BO. Noonan aynd1otM. Lat'l'C~ 2013;381 (9863):333-342. j~] Solomon 80. VACTERV,.,ATER Aa$0C&llkln.. (),Jll'wk,J JRa1ttDJ,.. 201 t:S;Sl!i. ta] TalazotA. EMngh.l P . Kokltl ZI<. 111 al N

... Limitations of Visualization Technology and Virtual Instruction in Medical Education ..~ '::'.:,~:~,:~~~-~::::.':'.::aby OMS II MU-COM oad 01. Oo,M D,feo,, PhD ..... .. 4:-> --____ Mil.IA"___,_ lMIUtsll\ , Introduction Problem-Solving Skills Technological Limitations Traditional medical education has recently seen major changes due to the coronavirus (COVID-19) pandemic. New pedagogical methods, including augmented reality (AR} and virtual reality (VR), arc on the rise as alternatives to traditional teaching methods. While AR enhances real world experiences by overlaying information, VR immerses users in a computerized world rather than enhancing reality. It is crucial to understand the limitations of these learning modalities and that at best these modalities should be used to supplement and not replace traditional medical education. In a study where arm cadaver models were used to implant nerve fascicle electrodes, it was concluded that having this micros urgery conducted on cadaver models before patients is necessary especially for the development of operating protocols 10 be established before praclicing 1his high-risk methodology on nerve structures with great anatomical variability. One challenge for VR headsets is 10 reduce 1he latency of the video rendering time, whic h if is greater than 15 ms, can cause a sensory mismatch leading 10 cybersickness. Also, wireless headsets struggle to presen1 the video quality 1hat wo uld be integral to a realistic virtual learning environment Physician-Patient Relationship Physical inte raction cannot be properly replicated wi1hin the confines of a VR o r AR learning experience. In current medical education models sllldents are ta ughl a --voiceless dialogue' ', which includes 1he way the physician approaches. touches, a nd dea ls with the patient. making the patient feel whole. respec1ed a nd integrated; a satisfying and rewardi ng feeling that can have positive mental outcomes. Touch has limbic connections to past experiences, meanings, and emotions and there fore allows a dynamic assessment o f o ne of the major osteopathic practice models. the biopsychosocial model. Conclusion Virtual and augmented reality are rapidly being adopted in many academic fields, and while ii is almos1 inevitable that these will be used in medical programs, it is important to understand the limitations that these learning modalities pose. VR and AR learning environments can be incredibly fruitful, but in their still-nascent state these 1echnologies are best used as a supplementation to 1ried-and-true educa1ional approaches rather than a replacement Financial Challenges In a s1udy published in 2019, Farra c l al compared cos1s ofa VR simulation and hands-on training for an evacuation training event for nurses. It estimated the total cost for the development and VR training simulation for 34 nurses to be $106,951.14. Of that cost nearly $80,000 was for the development of the virtual simulation. If this form of education is adopted in medical programs, they will need 10 develop many unique !raining simulations, which will rapidly drive up the implementation costs for this educational approach. rofessional and Interpersonal Skill evelopment raditional teaching provides snidents with early xposure to their first patienl in the analomy lab. Donors, ike patients, surrender their bodies 10 future doctors 10 be andled with care and professionalism. Student doctors evelop empathy and respect for donors under the uidancc of experienced faculty and academics. nstructor-lcd discussions pem1i1 students 10 express their ersonal views on inevitable topics like mortality and trief. This prepares students for future difficult patient ituations and enables them to develop coping skills. T- l . U.. ElIL JA.\IA?37:IIS0-118 1 110\lo~nh PA.Ccllo PJ. 1997. The: OCC'\lm:n o(,1nwl simula1ton$ic;l..ncb Dtspbys symptoms \\hC'n an IIMD was used as a pen,orgl , tc\\ing $)'Stem. 18:107-1 16 Kr,,hcnbuhl $\i .C,~ara P. Sttcgl11,T. ct sl. Rctum o(thc cada\ C"r: Key role of aJ1J11onnc d1sshon (OJ plJISCIC' $UJSCfY m1dc111 craim,-a M tdidM (Bolti"'"). 20 1U6(2'9);c7S28. doi.10.1097lMO.0000000000007S28 \VttQ St. llatri.s CE. Ki~ WG Ilurnan ~ s ana1omy a crucial lil'l'lt 10 tnt00r3St l'CSptttandcampus.on u, siuk,us. Clin A,.111. 199~:8( 1):69-19. doi: 10. 1002.ca.9SOOSOl ll  ...

... ' History and Evolution of Virtual and Augmented Reality in Medical Education Joseph Jansky 1, Victoria Nobari1, and Dr. David Dufeau 2 l OMS-II, Marian University School ofOst,opathic Medicine 'PhD, Marian University School of Osteopathic Medicine jjansky082@marian.edu; vnobari297@marian.edu; ddufeau@marian.edu; Introduction The history and use of \mu.al and augmented reality dates back to the early 19th Century, Charles \Vheatston~ an English scientist, and in\entor, disco,eted that the brain interrupts stereoscopic photos and paintings differently than 20 images. His r~arch dem0[1$trated that using a stereoscope to \ie,v two images side by side allows the ,i.ewe:r9; brain to interpret the nvo 2D image!!; as one Evolution of Virtual and Augmented Reality Discussion and Conclusion As the world began to realize the unique power of ,irtual reality, the uses became more and more di\enified. ln 1981, The National Aeronautics and Space Agency (NA.SA) began looking into wing Ghosh studied the e\olution of illustrations in the anatomical field from the classical periods of Europe to modem times. In summary, illustrations began to emerge in the Late ?lo.fiddle Ages. The development of illustrations pro,lded detail in different anatomical components.9 .As time mond along illustratioos began to lose their initial artistic component and began taking a more scientific rendition. The 20:!:. century saw the emergence of photography that could capture anatomical detail at a higher le\el, and finally with computer technology arri,1.11,g in the late 20lb cenrury anatomical education has utilized ,arious imaging modalities to enhance medical educatioo.9 , irtua.1 reality as an educational tool for astronauts in training3. cohesin 3D image, 1 The rationale behind the use of ,-irtual and augmented reality is primarily rooted in the principle of interac:ti,-ity, ,,hicb create.s a world where the indi,idu.al can interact \\-1th the material at b.and.2 In the 1990's, the use of drtual reality was appearing more in media and entertainment such as the mo,ie the ?v!atri.x and the Nintendo \irtu.al boy1. During this time, the u!.e of ,-irtual reality was al!.o becoming more popular in medicine. One of the fim uses of VR in this field was to help visualize anatomic structures to help prepare surgeons for surgical intenentions .4 Augmented and Virtual Reality in Medical Education Early History Monon Helling, in 1957, decided to use this idea of interacti,ity to create a 3D interaeti\e stimulation and experience. He in\"ented the " Sensorama l\facbine", which combined 3D modes with tm.ell, pbys:ica1 vibtation of the seat, air blowing mimicking the feeling of wind blo,i.i.ng. and distinct clear sound that ,aried depending on the indi\iduals input.J Technological ad,ance:$, such as augmented and virrual reality (AR;'VR), ha\e introduced their way into medical education. Both AR and 'VR $?em from the initial use of illustrations in medicine, a technique that has been shown to have varying influences depending on the discipline of srudy.S Augmented reality in,olves the ,irrual world superimposed on our surroundings and bas been useful in certain aspects of anatomical education. The combination of cada,eric dissection and augmented reality can teach students precise anatomical landmuk:s and build an understanding of radiographic information (top pane of figure).' AR and V"R are e,en further de,elopmeots of the computer technology that anfred in the late 20m century. Tbe utilization of these new tools can be efficacious towards medical school curriculum. I() Howe\er, these ad\ances are not without common pitfalls that are often seen with technology.11 It is ,atuable to understand. from an anthropological standpoint, how history and evolution can teach us bow f ar we haYe progressed. That progression gi\es us a reasonable undemanding on what humanity can accomplish as time mo,es fot\i.-ard. The increase in technology and \'arying imaging modalities in medical education \\lll continue to evoke and revolutionize the way current and future phy:s;icians are taught. References ----~a_.,,.. ., :;,_. __. _..,..,_ a-,-~ I. _..., ...... 2. ...... _,,-- - ). .:=-...a;::.=--~~::;:~~ ..-1.__ ....,-.-.---~ =--.: ~=.:.~~~=~,~-==-..~-.. .-. ::.:.~:::::..-:..:.:-::::.~;;~~--;:~::~~-r:--..- .. .....,.....-im, ,...,., .&. Inn Sutherland continued elaboration on Heilig's initial idea of bead-mounted isptays by adding r.,.:o cathode ray tubes near the user's ears. This addition is still used e\en in bead--moW1ted displays today. 3 1,, -~ ~i-o ..- - - ":::..:=--."'.:,:,...io::-:;,;:::~!":;:7::,:::;--J;;;;."'.. _._.,_ 1. ;;=~=::=:.:::==-.::-:.:~~=-. .. . . . . ~.~ ....., ~ . -... ......,~..'................., _........ _ Ut.~....... ,.....,...,., The similar tool. VR~ ean also be utilized in medical education. VR allows for a completely computerized simulation. Medical education throughout the put three decades bas began adopting simulation-based educationi. VR can be used to simulate any medical intervention "-ithout any of the risks associated. This allows for an environment where students can learn techniques and become familiar ,vith thtm. SurgLcal education can utilize VR to teach msdents the tools and steps nee~ to perform a gi,en procedure (bottom pane offigute).s 9, -.....-- - , . _ . ,....'l>,.,...../;111"_, _.___ ~~..-:::=.:.:.~~~~:a:i:~:-::.:.~:--"1..,,.,._ ......_ \N,...................... .. .... ..... ..-.,,,_.._.,......... .. ,11 ...~ . _. .-... .........._ . ...........,.,...v,..... , ........ ,. , First Second tWV,.....  ...

... Kisspeptin's Role in Bone Cell Differentiation & Growth Jordan A. Matz, Julia M Hum, Ph.D. I College of Osteopathic Medicine I Marian University ABSTRACT BACKGROUND PRELIMINARY DATA Introduction: Kisspeptin together with its receptor, GPR54 (Kiss1 R), are known for their function as the principal regulators of the onset of mammalian puberty. Given the characteristic growth spurt and bone development that occurs during puberty, recent studies have provided insights into the role kisspeptin has in the control of skeletal homeostasis as well as bone cell differentiation. Objective: The present study hypothesizes kisspeptin and/or its receptor are expressed by bone cells and provide a communication pathway to regulate growth and differentiation. The objective of this work is to establish the expression patterns of kisspeptin and Kiss1R across various bone cell lines, as well as changes in their respective expression patterns with aging and mechanical stress. Methods: Osteoblast precursor cell line, MC3T3E1, was cultured and cells were harvested to perform western blots to characterize the baseline el(lpression patterns of kisspeptin and Kiss1R, respectively. Ongoing studies: Next, the role of kisspeptin and its receptor will be investigated in MC3T3-E1 cells placed under mechanical stress, via an orbital shaker. In addition, the expression pattern of kisspeptin and its receptor will be characterized in the long bones of young and aged mice. Future studies: Examine the utility of pharmacologically targeting a kisspeptin signaling pathway to promote anabolic bone growth. Kisspeptin (KP-10): Human gene: KISS1 Receptor: GPR54 (Kiss1R) o Via GPCR signaling pathway Most notable role: o Principal regulator: Onset of mammalian puberty Via direct GnRH secretion initiation o Disruption in kisspeptin-GPR54 signaling system: Hypogonadotropic hypogonadism Source in humans: o Majority neuronal cell bodies localized to: lnfundibular (arcuate) nucleus Rostral pre-optic region Previous Study: KP-10/GPR54 signaling induces osteoblast differentiation in C3H10T1/2 cell line (Son, et al., 2018) o KP-10 induces osteogenesis by acting directly on bone Figure 1: Kiss1 R expression in osteoblasts (a) Sample 1 Sample 2 Sample l Sample 3 lSg GPRS4 30g ~-actin ~-actin lSg 30g GPR54 Sample 2 sample 3 0.9 {b) 0.8 0.7 .~ 0.6 :::, ~o.s E g 0.4 -~ 0.3 0 0.2 0.1 0 lSug Figure 1. (a) Cells from the osteoblast-like cell line. MC3T3-E1 , were cuttured and harvested. Protein was extracted and evaluated by Western blot at a loading dose of 15-and 30-mg (n=3). (b) NIH software program, lmageJ, was used to quanGfy GPR54 and b-acGn, FUTURE ENDEAVORS Investigate whether GPR54 expression changes when introduced to mechanical stress in MC3T3-E1 cell line Examine utility of pharmacologically targeting the kisspeptin signaling pathway to promote anabolic bone growth Characterize Kisspeptin/GPR54 expression in other bone cell lines, such as the osteocyte precursor line, MLO-Y4. Induce expression of proteins normally activated during bone cell differentiation by treating GPR54-expressing bone cells with kisspeptin  ...

... Efficacy and Benefits of Augmented and Virtual Reality Based Learning during COVID-19 Jessica Caruso1, Lauren Harmon 1, Gabriella Born 12 , David Dufeau, PhD 12 jcaruso884@marian.edu lharmon441@marian.edu 1Marian gborn502@marian.edu MARIAN lJ,- \ ERSIT\ ddufeau@marian.edu University College of Osteopathic Medicine 20epartment of Biomedical Sciences, Marian University College of Osteopathic Medicine ~---------------------~ Discussion Introduction Traditional medical education typically consists of two years of didactic, lecture-based education {Years 1 and 2), as well as two years of clinical Until r ecently, VR and AR t echnologies were too expensive to clerkships and patient interactions {Years 3 and 4) December 2019: COVID-19 (highly contagious virus) global pandemic closure of schools Implement into the educational sector o Accessibility on personal devices allows for reduced cost o COVID-19 has led t o extensive disruption of medical education and training, causing urgency to implement and develop solut ions to combat this COVID-19 pandemic highlighted new challenges in education educational disturbance o Medical schools, educators, and students propelled into world of o Considering the COVI0-19 pandemic, it is important to be prepared for and adapt to new methods of learning in education total computerized learning o Push needed t o implem ent novel, unfamiliar technologies o Virtual-reality and augmented reality (VR/AR) provide a promising future for the enhancement of medical education Objective: This review aims to evaluate t he benefits and efficacy of augmented and virtual reality, especially during the COVID-19 pandemic o VR used to solve or confront modern day issues 0 Met hods: Using several peer-reviewed, randomized t rials, we review t he advantages of implementing VR/AR into medical school education o VR allows for specific COVID-19 education and patient care practice in low-risk settingn For more information regarding die history of ,;if'wol re-chnology, pJeou see rlle Joruk'y, Nobori presenroricn (Hisrory ortd Ew,lurion of V.-rruol ond Au91Mnred Reolir)' in M~icor Educorion) in r.his symposium VR allows for social-distance based learningu o Flexible, individualized learning vs. risks of social isolati on10 Efficacy and Benefits Benefit s of continued, safe learning outweigh potential technological challenges of implementing AR/VR into medical education Education More intuitive interface fosters increased motivat ion to study compared to tradit ional book figures11 Conclusion VR/AR use has 24-hour access compared to traditional cadaver laboratories VR/AR can aid in situations where cadaveric dissection falls short9 o VR/AR offer students an " undo" option o Allows visualization of structures too small to see with the naked eye' VR/AR aid students in mastering topics sooner and mastering them better 11 Decrease frequency of training and increase ease of traini During t he COVID-19 pandemic, we as a medical community are faced with teaching first year students all skills necessary to become proficient in anatomy, physical exams, and more, virtually Dec,ease costs and inc,ease etricier.cy o The pandemic offers unique opportunity for implementation of new Increase learners' self-confidence t echnologies 11 o Improved long-term retention and alleviation of working memory11 o Enhanced visuospatial learning AR can offer medical students a unique sense of proprioception and personalization of learning VR/AR allow university faculty to make their own anatomical models using scans from free databases,. Overal perfonnance improvement However, virtual instruction does not have to stop beyond the COVID19 crisis Increase skils cf leamers o Various ways in which virtual technology can teach medical students Bette, leamillg of anatomical positions VaJuabJe approach to slandard and unified education so-called "soft skills," such as empathy, engaging in difficult conversations, and more Because students have traditionally attended universities where Experience and Skills passive lecture styles, sub-opt imal resources, and limited time for VR/AR aid medical students in developing spatial intelligence9 cadaveric dissection have been used to instruct hard-to-master topics, it is time to look towards expanding the learning repertoire of medical students and allow t hem to personalize their educations o Enhanced ability to mentally convert 2D 3D Images o 20 30 deepens understanding VR can be utilized to render virtual patient encounters6 o Comfortability in leading difficult conversations VR can allow physician-ln-tratning to e>eperlence clinical encounter from perspective of patient6 o Empathy towards age-related disease (i.e. Alzheimer's, macular degeneration, high-frequency hearing loss) cost reduction and increased frequency of hospital-wide triage training L ._ 1,, '- o Supplementation of traditional in-person instruction -'l.-1.S.....,L.!H>o.L&-.-.t.~t)O-"llt-~-Wti ._lo,'o\-,llllto!._._ol&M."". . ~ - . , - S . - - - O i ' /.41o\O.lll,.~'-Ollo.1-.J _ _, ................~ '-a,.S.S,,.""W ........ o.c.,...1 J, f t ~ l ()O!Qt,Y-,i.,,1- , t ,T~. ,,............ . ..._ w.....,....,o,..,.._ -;i...~. . . . ... .,..". .- . . ' """'--..... - . . .. . ..;; - " " ' " " " ' ' - - - - - ' " '...'"' ............(1e1) -11,_ _ _ l .,lb.lOt1/fU,CIICU.l~ ,..;,,-.t. M jlOU,,_UJO)Q.@11., D,,,,,, l., ' - , , . . _, l l . . t . ~M.l.r,l(Dj)U..._,-,-., ..--.1 ......_ , _ _ . . . . - , , - . ,...--..r --,.--.,.10iil...... 111.Sl~.i.lll.JU Interactive exposure to virtual pat ients Surgeons who used VR simulators made fewer errors and took less t ime than those who did not3,1 References "'-"-"lti'""""" 111.11'.r>J/~ C..S..--1 ...... ,.. .lk~.... lllOl't.""' "-'"'" l""'--..._--1-...1o..- ..,.~,_,.....,.,.. ,..,_...,._"'-"""'-"1.'&.$.lt-Mt.....,W.U)(ltJo..."1il. U. -.s....,,.. - l ~ f . . _....1...... t;,... f1COAO-ll.'-""'-lll,,.._ll,1l ..... XQQ..,.llJI.. -.i.o.lOOl,'j;,eo.llOlO.SJ ,,_..,,. .,.,....,_,,,..,,c,....-~;1..... .,_..,_,~,R-=o<. U -1,-.._..; it,_, XQQ..., '41-6k., lll.>111',\ao.!Olll4~1l w .. ~ -  ...

... Individualized Exercise in the AVA Cancer Survivor Population AdsmCofya'. Jacob CofYor, Abii,ail ~ . Ja5ica Ricks'. Ni<:holas~. Danielle H&Gey1 , Tammy 5a;dyk1 JamieRenbe,rge,-1 1 1ndiana ~ Scf\ool ol .\4e6cine, lrdanapoliS. IN; ~a.,anen University Scf1ool of Osteopathic Medc:ine lncianapob. IN. JV&ndMlilt U niversity. N ~ . TN: 4lrdanapob Corrmunity Hulthplex: 1 lncbna LlnMtrsity ~ lkvversity lrdanapois Sctm ofHulth nd H\a"IW'I SciencH fl'?I INDIANA UNIVERSITY Ii.ii SCHOOLOfMEDICINE lnckena Unrve,sity School ol l.iedicine aod lrdans Oneal and Trans/$bonel Sciences Institute RESULTS ABSTRACT -~. ...,__..., __,.,._ ............ _,,..._....._ ... ,......... _..,_ ---fl.r.-111 . .r.----.. -00~. .,. . \/Cn.-.JMf- - SUMMARY and CONCLUSIONS '"'---fflW,_C#.,--.-.,t.,....W.;,-ho"""O _,,,,u,.'fACt --N.....,._..,t11..r1-Ur,t11_...,...,""- ,,.1oo,.,JoY--"-' ""',..,,_...t1,;:o,1_.,..,.,._.,,......o _._,.......ea_,....,. ..... _,,,..,. _ -----'MIGl_w.,,_... i,,..,..c, ~ lt..l_..,...., .................- A'tlti:&ho,. M-or-,-_,_._..,._ . ..,. .,._.. Percent c/langes in trial fitness outcomes by client ----.-.. . . . . . . . --.-.....,u,o ll>_ ..illl...__ .,_,,,tl60,_....., n1IIJ O . . . , , , - . . . .b h o t - 1 t " . llhon... llo_ l _ _ 4Vlll:S---,..~-....- ,,__,.,_ ft,,.,..._N_:,,.,_ __ -..1oo.... ,..,111:... -,~1--,::--..-..u,,_ .,......,__.,...,_.......,.,.r11:.a.w-,..._.. .. ..... ..., . . .lttl&$ f ______,,.__.tll____,, ._....... -"---=-- ,w= Nu:.,,- j ~j .,. ,!.. - - - - -..-.........-"'II-""""'"'"""" _,,,.,,f.. - "''N~Oft....,I ___IU_,_,_M,t_..,.,. $ o i - - - -n.olioo""4t,--Mll-lil'"l. . . - - """'......"""""'Iii'"'......, ~......_......... " ~.r,,,1,-.,"'---~-'-'" ... -----"" --.-----1111-II.IM,otw!MuollM-lrd......, C -t, __ .. - --C,,_,,d_ll ~...,.,.a,.-~~"'~_...,..,,.,....,__.~ _ ,., , ~,, ____ _ _,.. JC.,O- ::01~tt).l~l&-::tt ll!l,UJI,_ ~ t .,..,.v,,_ ,...,.a.,,....... .,..,.,.,.,.,. ,-o._. .........,J.~a....,1,,0:,., ..,,,i:.i,.... "'1~ ~ ~ O ( l......._ _ . . c..ao,$-.-- ...,_ _ _, ......,.... ...._ ...... , .,.,.,.... .__ "'0...C,,J UfflJ,,-....,a,""'41.e . - ~ - -... ......, _..._ .. ,.._.., _ ~~:.,::r.=:::..~~~~o':o-.. ~,,.i,.uc.- Jllo..,..~.. - - I N ....lolcn.1hp .. _ c...-, ""' xi. 111'~' I MiHP STATEWIDE IMPACT 0----.,...11""Vli.!!Ji.- - t : , , _ ~ _ _ _,. ~ l l ! S f J J ~ - OPfft-' ~-.:fltN ,_._.... ,ldtin JINMttnplcwppo,t.,..tMQ)'to ~ - - ~.... 11alewtdtdlltlk-ll -M"thi.borlo,ylNtcMlffC,llp ""'"""""Mc1Plrt,dprttt11,ff0fl'I -comtfloflllcMNto..,-...t tM~oftt1W11..,.-.1 ......... ~ h o n lhe ''"1-tm hlilatiof -- do,;,. -v.,.,_.._,_ _ C.ilo 01it111W .....,,,._ilk,i,_l'f.AM

1 - ....... t._ _....., h ::.::...-::=::2-1"'..,,.,J"'"" OiHro,...,,.,_,_ _.,._..,..111- ..~loh .....,~" ~ ... -....,..,..""_ c.- ~1)111 ..... , . , . . _......., ...... - +--=I--"'"" P1t<.1\11~!"'>= ....., it,.,a- o,..ei,,,.~---..- ------- . . .. -.. --..---- ,S.,_..,l>_lttl .............- .....- ....- I JA- - -- ' - " . . . . j l l l -. . A - -C M otO--C.,.'>:: l t;..J l.a,a,11 -,.c...... ,,..~-=--+--~'1-~=1-~=i . .I ... - ~ IN~ f t l _.,.,,u-.,,.....,,.,v..,t~ - -1.Ml'fS~P\u~ e...----,-,.--~) ..,..,.._ ___, ,.. REFERENCES 1 _ , o .. RPFS itll:tlt'geM:.ltc:'.lelncld,gh.&Sub-~~ RPFSilh1A'Cdsigrif,ow,1~~at.crfw:irfcn'Cl"lto1~ ~,rca,ra,Ul'lll'Urt2ditt~ hFR0.11S S nct,....,_,00.0,,,,11~,_..,...1,;o ..._,._~,_ ..... - 5,ffll_,...'lol,_ ...~r-.--illl-"O~ ,4___ _ __ .... ,,,_ -""'...- .... noa_,,,.,A&.S.IM--~,.,..... --~_.....- ,-~-..------ . ............1'1;1-. . .. . ,........ _ _ _ ,_,. ..,,.,,. :.,.,.., ~ - n _ t.l-r,aW - -<..Slwo.lAA ........ .t -.-J1_...,_ ..,o-.11i,_ _.,.~-"II ..,.,,., "' _,,-...,.._.,-.,...,.i,-~"'"'"""----~ - t ' d w M d tM,t..._ .._,. _,..... . . .- :161'-"'"'l>:Dl-41 .....__.. , . .. , _ . . . - -........~ 1 _ _ _ .._ Materials and Methods " Psyc/losocial and Fatigue Outcomes ...._ . _..... ....,,..._"4U'I_ _ _ _ _ _ _,_," _ _ _ ,__...,., , _________........... an:.. ~ I" i J l ~ 1t - -.. ._ , _ _ _ _ ..,._.._....,_,....,,. YO:- --dtf'I' .... ...,_,____.., ___ "'""-"----~1, __ ..,_~,~-- __. .......... Percent ad/lerence g -A'!'Ct_WNOl...-ll'ftt.,,....11 _ ..,..._..~----.tt"-'1-lflf - - - - - , . - -.... --:\11111.._ _n,.....fllln-.,-- - f-l'l;lfl--Ni - M --t#----,i ,,_..,,.._,......,IHIN ...., ..,,_.. ,._,.,..,..._ .,.... ,,.._,__io--t11-Jl~-----tfllfoo0_...., ,,..,.,,." .. OUR TEAM =:.:.~-:=~~. .--"" . . . .....__.._.... O..----.. 1K;,Jt11w111>rn--U) 0 -1 ......_ . , "'""' ~Htdto.-11111.,.tll-latjfl--'J ,... .. _ ...,.~.,.,~,.~oo--.,--11'4U.C, _,.._,_,_, ..,...,., _ _ _,..._ .,.di,,_ 1'4111__ _ . , . _ _,_.,,. ..t _ _ _ _ . . Average c/lange in primary fitness outcomes J ,, ~ ~' BA CKGROUND -~-A' r~ - --..--tt111...,,..._ .._t!.,~-"'~ "'""-....-.---~"-i..1,,.,,,._.,_ .... ....- '" - - - - 1 " 1 - 2 ~ aotc11.........,. ... , ....._ _.,.-t11.-N1t,.,.__....,.....,.._.._,.,..,o,..,AN;I .... 1ue,-.,.,.,._., ._..~_..,..,.,.,.. ,.....,., .._ ...,_.,,.. 1,,_.... """"H ..........""...... IL!,9flll,_. . ., . , ~ 9QII............ - - - ' " ' "...,.. .. _.,.._.. ....~ , _ .............O,ffi...... ,,,,.~ MV - ,,.I l...w-~ _ _,..,,...ltll_ -.11!)1,, tllP")SZ!>ID ...,.~IIM, lu)W II SN1,i7>.-..,_,,illoc,a _ _ ,._ 12 :-'".. ,._,.,"t1">'.__"_e1.,,_ --- _ mu,.i,.1)a ~1alJSc,__._ .._..,(-r1""'.,.,. ACKNOWLEDGEMENTS We'M1Mlke Dlhri.b:inre(bggy, PN>br thc~istclll :wal)'l'i'S cnlhcm)d'odai~ Wt:ltto'f>..-RDl:h:n...blinSc:M'IMbhc!r~:t~I,,. .aCW!l'l91.e~~toNl~t ~bdi!ylo -....,.,,....,.  ...

... Pathophysiology and Management Approaches for Hypohidrosis and Anhidrosis Ian S. Holt, MS 1; Alys S. Jordan DO 2 ; Bryann N. White DO 3 ; Thad E. Wilson PhD 4 1 Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN; 2 Navy Medical Corps - Flight Surgeons, United States Department of the Navy, Oceanside, CA; 3 Emergancy Care, Comanche County Memorial Hospital, Lawton, OK; 4 Department of Physiology, University of Kentucky College of Medicine, Lexington, KY; *Corresponding author Ion reabsorption in the sweat duct Eccrine sweating glands are divided into functional units: I) a bulbous secretory coil that generates precursor fluid , Disorders of sweat output are expressed as systemic or focal (i.e. , confined to a specific skin area), and 2) a reabsorptive duct that transports the fluid to the skin surface. The secretory coils reside in the deep dermis and as increased (hyperhidrosis), decreased (hypohidrosis), or lack (anhidrosis) of sweat output or hypodermis and consist of clear cells, dark cells, and myoepithelial cells. Clear cells are the primary serous when compared to sweating requirements for thermoregulation. secreting cells and the likely source of secretory disorders of the gland. Dark cells are responsible for exocytosis of been described, and is estimated to affect 15.3 million Americans, severely affecting these patients' Hyperhidrosis has previously Na - - 1---+ (ENaC) many of the non-ionic constituents found in sweat and are associated with certain anhidrotic sweat glands, and in quality of life. In contrast, hypohidrosis and anhidrosis incidence rates and etiologies are less addition have secretory components of their own. Myoepithelial cells surround the secretory coil and contract to clear. Neurologic conditions, such as multiple sclerosis, can impair activation of sympathetic provide the structural rigidity necessary to generate pressure within the gland. The reabsorptive duct contains a two- nerves, and other disorders, such as peripheral neuropathy, can reduce sympathetic neural cell thick structure that modifies the fluid being transported to the skin surface. transduction to sweat glands. source: Goldsmith lA, Katz Si, GIichrest BA, Pa11er AS, Leffel! DJ, WOiff K: Fltzt,atrlek's oermato/ogy In General Medielne, 8th Ediflon; www.accessmedlClne.com Classification ofHypohidrosis and Anhidrosis Causes The sweat glands themselves can be occluded (malaria rubra), Neurologic - Multiple Sclerosis, Harlequin Syndrome, Ross Syndrome, Diabetes Mellitus damaged (tattoos), dysfunctional (cystic fibrous), or missing altogether (congenital anhidrosis) . Exogenous compounds, such as anticholinergics, can prevent acetylcholine from activating the sweat gland. Sweat Gland Dysfunction - Cystic Fibrosis, Miliaria, Cholinergic Urticaria, Atopic Dermatitis, Congenital Anhidrotic Ectodermal Dysplasia Endogenous factors, such as increased plasma osmolality, or physiological Sweat po'--~- -+=~ - - loa\--'-""> 1' IOllicie and describe some possible management approaches for the health care practitioner. If left untreated, hypohidrosis can predispose an individual to heat illnesses, such as heat stroke, as well as skin barrier dysfunctions, as sweat secretions are needed for the control of flora, immune Image Citation https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/multimedia/sweatglands/img-20007980 defense, and skin hydration. https:// accessmedici ne.mhmedical. com/Content. asp x?bookid= 392& Secti onid=4 l l 3 87 8 2.  ...

... SE-dnveo Tfs are cntlc:a! for MPNST v1ab1l1ty peripl\eq,! t1t1Ne 'lll'lH-th tumor {MPNST) Is 1,n agg.rHt~ UofComa tcnown to t,a, t1111 111:r.din:3. c.airt@ of dHth in p.uienu wtth "Ul"0fibr0ITlit.t0-siS typ,t I. Abo1n SOK of MPNSTs hubor SOft'liliC mu1ations of cort- componenu of poly<;omb ,tp~niv" compt@J:. 2 (PRC2) , such H EEO l.M/or suz 12. AS ii m111jor COl'l'lpltl)II. rHpo1uiblifor maintenance of truscriptioMl repre-ssion. PRC2 deposits trim_.Ulyl:nion :tl lysine 1.7 of hoi1tor,t1 Ml lM3K.l7md) . The- lou of HlK2]me3 due to defective PRC2 has t>M-n identified as a bia~rii:ar of MPNST. To -unden.tand th corueque~H of PRC1 Ion in Mft~S.T, we profiled epigenetic chan,:es accompanyina th@ loss of HlK27md ilnd ld1-ntifi.-d ii ;roup of J.UP9l" t1nhanc,ar (S:E) drivn tr:r.nscriptfcn factors (Tfs) that were- .actiYa.ted d~ to th@ toss of HlK21md. We hypothui:e Wt th.-se SE-drin:n TFs u uenti11l 10 MPNSiT surviv.a.l a.nd c.a.n be tarsMed in treating M.Pll~T. Mailis,.int 1A =-' _... _ " ..-1 1=-..,.:. . _ 2A ... 88 Ii I j I 3B s1RNA Fli,x1Plate rr,ve.ls top SE~ 3A ---, --~-- 3C ... [1S,C) Functiona l PAC2 depo5 its H3K27~l tha.t milint.tiru g.ene rtpre.ssion wtlile inactive PRC2 ma:, t-e11.1tu In 1~nt tr.a.ru.eript ion. (JA) A cmtomi.-::~ :unall interlerfr.a RHA jsUIJfA) screen usin3 fle-xiPlate t,o lf.Mck.dOWl'I Heh c1ndidn1 core trilnscriptional .-.;ulat,ory circuitriu. (C.RC) TF WU perfonne-d lo invnti9111t dlei,.rkfel'K)' of /1,PttST cell lmes to the-H identifi9<1 SE-driven ruuked from b-ln hits whil (]CJ gatn of lilK17ml ,1nd loss of HlK27Ac ~,1r ~ir g'ln"I! promoters demo nstrate PRC2 reg.utati:,on . paneL of N.PKST Hll1 - d~ --- STS26T. T:265, ilndSTl8 - 1 . ( IE) In wing d'oxyqclintirHlucib l MPNST cell linM to ovitrxpr.-ss SUZ12 Le-ading to r t-stored PFl:C2 function , wit observed il gain in H3K27m1. Ii~: w~~ 5tlldy: ~" lE Thli fo llo....;n1 thl'ff { -- ______ ... _, Sf..,_1' PtlOQ2 00< SUZ12 Vinculin H3K27me3 HislOMH3 9A i~uCY'e. 1l65 T26S D4 siRNA S188 14 04 slRNA 68 !111.!!. Pf ,oxc1 , HOXH , ilnd PAAX2 knockdown !1 I I. I le (U , 8 ) wu,em btot d@moru.ttue-d in ter-re;ulation betwfft'I tht!s.e St:-drive,n CR.C Th through siRNA KO in H65 oi nd ST88- l -4 1'::"L-,c-':::'--==-== = = l ttGS 7A 78 I ..::_ .~r--~ -~ I.--__ .,_ --- - ,.,..... -- . :... ,, ... ... . . , : _ ; _ ~ .4 through :siRHA reverse trans fctfon to validAte on MPHST cell s11rviv11t. tino:i.ut in TI:65. PRRX2 .,.. Nltl ~,;;;;,=.:,;;;;;;;::; =-- ;,;::;;,~-~;;;;;;;;;;;;j :~ ' i__.::.. lnter-regulauon bet.,.een SE-dnven CRC ,V.ctuclien : --------------------,. CUDC-907 selectively nrceh SE-dnven CRC, 6A lC 10 __,_ (U.) .,b I du11l P13K ;a.nd HDAC inhibitor, CUDC-907 1!-xhibited lowflt IC50 ift T26', indiuting enhanced ~,,PNST senskM ty. (! B, C) 1C50 :shown hlir& wer from single agent m1a,ment w;ing. Pl-101 or (24) Upon PRC2 l'il$.tor;ation in doxycyt line treiiLte-d ;nd,u;ibte c-ell llnu, ChlPuq shows g@nom@wld@ gain of HlKl?mt!-3 .;Lttompanying ton -of H.3Kl7at. (1 A) NFl-aociated tumor goes throu5:h the m.t.U3,nant transformatM>n accompAnffll with thr st:agn of anatic alter.itiom before deveto ping i nto MPtilSTi. 18 11\~l I ~ ---"... ,,_ - cuoc.qo7 i~ mo re potent'" treatmc MPNST,:! (7A) Ben on och oth-ir Ou.II PUK .and MOA.C inhibitor CUOC-907 trHtmen.t e.i,;hib!t.e d a pount killin; ffect in MPNST &nd M1ectivcly deplued ti..n PRC2.d@pendent St.drfven Tf's  ...

... rt Elizabeth Baugher, Ashley Becker, Tamara Batarseh, Austin Cantu, Evan Carr, and Sumathilatha Sakthi Velavan Marian University College of Osteopathic Medicine, Indianapolis, Indiana Inhoduction Multiple osteochondromas (MO) is a rare genetic disorder characterized by accessory bone growths usually stemming from the epiphyseal plate oflong bones. MO affects about l in 50,000 lirn births. Complications of MO include joint disorders, difficulty with movement, loss of circulation, pain, and denervation. Malignancy occurs in I out of every 20200 cases ofMO.l Potocki-Shaffer syndrome (PSS), an even rarer disease ( <100 documented cases), is defmed by the presence of both MO and an underde,eloped skull. PSS is associated with underdeveloped intellectual abilities, motor skills, and speech. 1 Herein, a unique case of MO is reported in order to provide a deeper understanding of this anatomical variation for physicians in the clinical setting. This case was discovered in a male cadaver during a routine dissection. This unique combination of bone pathologies proYides an opportunity to better understand its presentation and necessitates further investigation on its pathogenesis. Figu n L Left forearm. I. ost eochondroma 2. accessory muscle 3. pronator quadratus 4. radius 5. ulna 6. lunate Figure 2. R.ight forearm. I. ulnar osteochondroma 2. radius 3. pronator quadratus (splayed from its original position superficial to the osteochondroma) Desniption A 66-year-old Caucasian male donor ,vas examined during a routine cadaveric dissection performed by medical students in the anatomy laboratory. Detailed exploration of the skeleton and organs was performed, and photographs were taken. Bilateral bony growths were noted to arise from the long bones of the upper and lower extremities (femur, tibia, fibula, radius, and ulna). An accessory muscle was found associated '-1th the left radial bony growth. Tissue samples were obtained from multiple growths, and histopathological examination was done. Histopathological examination was positive for osteochoodroma. Inspection of the skull revealed enlarged parietal foramina and elongated styloid processes. Other findings include tibia-fibular s;nostosis and abnormally shaped vertebral bodies and ribs. Discussion Results Figure 3. Left lower limb. I. osteocbondroma 2. femur 3. tibia 4. fibula Figu-re 4. Right lower limb. I. osteochoodroma 2. femur 3. vastus lateralis 4. tibia 5. fibula Cases of MO typically have no effect on life expectancy; however, affected patients are liable to present with a variety of clinical symptoms.4 Imaging studies performed early in the management of joint discomfort, limited range of motion, and denervation related to the limbs could diagnose and prevent complications ofMO. 5 Comorbid neurologic symptoms obligate investigation of the parietal foramina and entire axial skeleton in order to rule out more rare disorders like Hereditary Multiple Exostoses, Eagle Syndrome, PSS, as well as malignancy.2-4 Elongated styloid processes to the degree found in this case may be indicative of Eagle syndrome, another potentially unique comorbidity associated "~th MO. 3 Treatment of MO is usually conservative and supportive, but surgical intervention can be beneficial. 5 Due to the nature of this cadaveric study, clinical symptomatology and genetic testing were unavailable and thus limited the correlation of anatomical abnormalities ,vith proposed mechanisms of pathology. In combination with histopathological examination, the above studies could elucidate a clearer clinical picture for those affected with MO or similar disorders. Conclusion This study investigated a unique presentation of MO comorbid with parietal foramina and other bone pathologies. Continued research is still needed to provide a better understanding of this disease in the clinical selling. References J. Hl!:1'~ multipK011~omaJ ~ HO!l1t R.efwence NIH :bftpt:/. 9'.JUm.ZLih.gO\''~=-btdiw)multip~~i!'I 2. Potock:i-Slalm S)udmme Gottia Hame Reference - ::,llH httpt:1i~ gcn: "cocditioc:. ~ l}?l.dromt ] . Rsm..a D, Gothi R, Rsj.m S. Ea.&].I ~~ Thi! J.!Mtimjll'llI!Lll ofr:a4io~ &: fm.J.gjng. 2009 ..,,,90y.10,. 4, Bo\"HJ\", M\I.Jtiplt~oa>a.~tjowulofrutdiJWeJ. ~ 3 I>;l0):3. S. Arqu,u. HF. OUiodM:i.ll&om.a. .-ui. Outolo~ Study. I=~Ati:hn'tt o f l \ l ~ lOU JulO;Jl. Figure 5. Enlarged parietal foramina indicated by arrows Figure 6. Histopathological examination of osteochondroma from left lower limb shows cartilage cap. I. chondrocytes Acknowledgments The al.ttbors would like to than1: . larian Universit) College of Osteopathic Medicine for pro\idmg the resources and opportunity to resiruch. Special thanks 10 L,un Scheid from lht l./lli,mity of Iodw,,poli> for d<\elopUl,! hin<,p.,11,ology slides; needed for Iha case., as\\~ as Dr. Ke\-:in Gribbins and Arden Afower fo:r helping process them. The authors are fort\-er graieful for the donor, \\ithou1 "llom fh, shJdy would not be poml>le.  ...