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Wassef C, Rechter GR, Tatapudi S, Sambhariya V, Pientka WF. The Effect of Radial Inclination on the Stage of Kienbock Disease at the Time of Initial Diagnosis. Hand (N Y) 2024:15589447231221246. [PMID: 38164909 DOI: 10.1177/15589447231221246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Negative ulnar variance is a widely accepted risk factor for the development of Kienbock disease (KD). Variation in radial inclination has been proposed as a risk factor, but evidence thus far has been inconclusive. We aim to clarify the relationship between radial inclination and KD. METHODS A retrospective analysis of all KD patients from a single institution from 2007 to 2021 was conducted. Radiographs were reviewed to measure anatomic parameters and stage of disease. An exploratory multinomial regression model was created to examine the association of patient age, radial height, ulnar variance, radial inclination, volar tilt, scapholunate angle, duration of symptoms prior to evaluation, history of wrist trauma, and diagnosis of diabetes with stage of disease. RESULTS Fifty-seven cases of KD were identified, with a mean duration of disease of 33.3 months. A history of trauma to the wrist was common (53%) and significantly associated with stage of disease at initial presentation. Twenty-seven cases (47%) were stage IIIB or greater. The average initial radial inclination, radial height, and ulnar variance was 21.9°, 10.7 mm, and -1.23 mm, respectively. A multinominal logistic regression model revealed decreased initial radial inclination is associated with Lichtman stage IIIB or greater at the time of initial patient presentation. CONCLUSIONS A correlation exists between decreased radial inclination and more advanced KD at presentation, suggesting this may be a risk factor for disease progression. This correlation is strengthened by our finding of decreased ulnar variance being associated with later stage at presentation, which is one of the most widely accepted proposed risk factors for development and progression of disease. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Suhas Tatapudi
- University of North Texas Health Science Center, Fort Worth, USA
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O'Neill DC, Steffenson LN, Myhre LA, Kantor AH, Meeks HD, Fraser AM, Marchand LS, Haller JM. Analysis of acute extremity compartment syndrome using a genealogic population database. Arch Orthop Trauma Surg 2024; 144:149-160. [PMID: 37773533 DOI: 10.1007/s00402-023-05074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Acute extremity compartment syndrome ("CS") is an under-researched, highly morbid condition affecting trauma populations. The purpose of this study was to analyze incidence rates and risk factors for extremity compartment syndrome using a high-quality population database. Additionally, we evaluated heritable risk for CS using available genealogic data. We hypothesized that diagnosis of extremity compartment syndrome would demonstrate heritability. MATERIALS AND METHODS Adult patients with fractures of the tibia, femur, and upper extremity were retrospectively identified by ICD-9, ICD-10, and CPT codes from 1996 to 2020 in a statewide hospital database. Exposed and unexposed cohorts were created based on a diagnosis of CS. Available demographic data were analyzed to determine risk factors for compartment syndrome using logistic regression. Mortality risk at the final follow-up was evaluated using Cox proportional hazard modeling. Patients with a diagnosis of CS were matched with those without a diagnosis for heritability analysis. RESULTS Of 158,624 fractures, 931 patients were diagnosed with CS. Incidence of CS was 0.59% (tibia 0.83%, femur 0.31%, upper extremity 0.27%). Male sex (78.1% vs. 46.4%; p < 0.001; RR = 3.24), younger age at fracture (38.8 vs. 48.0 years; p < 0.001; RR = 0.74), Medicaid enrollment (13.2% vs. 9.3%; p < 0.001; RR = 1.58), and smoking (41.1% vs. 31.1%; p < 0.001; RR 1.67) were significant risk factors for CS. CS was associated with mortality (RR 1.61, p < 0.001) at mean follow-up 8.9 years in the CS cohort. No significant heritable risk was found for diagnosis of CS. CONCLUSIONS Without isolating high-risk fractures, rates of CS are lower than previously reported in the literature. Male sex, younger age, smoking, and Medicaid enrollment were independent risk factors for CS. CS increased mortality risk at long-term follow-up. No heritable risk was found for CS. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dillon C O'Neill
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Lillia N Steffenson
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Luke A Myhre
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Adam H Kantor
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Huong D Meeks
- Utah Population Database, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Alison M Fraser
- Utah Population Database, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA.
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Kantor AH, O'Neill DC, Steffenson LN, Meeks HD, Fraser AM, Marchand LM, Haller JM. Familial Analysis of Nonunion in a Genealogic Population Database Demonstrates No Evidence of Heritable Risk. J Orthop Trauma 2023; 37:591-598. [PMID: 37448147 DOI: 10.1097/bot.0000000000002658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To determine whether there is evidence of heritable risk for nonunion using a large, state-wide population database. DESIGN Database. SETTING Level 1 Trauma Center. POPULATION All Utah residents from 1996 to 2021 who sustained a long bone fracture and their family members were included. OUTCOMES The primary outcome was nonunion and the prevalence of nonunion among the patients' first-, second-, and third-degree relatives. The secondary objective was to identify demographic, injury, and socioeconomic risk factors associated with nonunion. RESULTS In total, 150,263 fractures and 6577 nonunions (4.4%) were identified. This was highly refined to a 1:3 matched cohort of 4667 nonunions of 13,981 fractures for familial clustering analysis. Cox proportional hazards did not demonstrate excessive risk of nonunion among first- ( P = 0.863), second- ( P = 0.509), and third-degree relatives ( P = 0.252). Further analysis of the entire cohort demonstrated that male sex (relative risk [RR] = 1.15; P < 0.001), Medicaid enrollment (RR = 2.64; P < 0.001), open fracture (RR = 2.53; P < 0.001), age group 41-60 years (RR = 1.43; P < 0.001), and a history of obesity (RR = 1.20; P < 0.001) were independent risk factors for nonunion. CONCLUSIONS Our results demonstrate no evidence of heritable risk for nonunion. Independent risk factors for nonunion were male sex, Medicaid enrollment, open fracture, middle age, and a history of obesity. Although it is important to identify modifiable and nonmodifiable risk factors, these results continue to support that the risk of nonunion is multifactorial, relating to injury characteristics, operative techniques, and patient-specific risk factors. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam H Kantor
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT; and
| | - Dillon C O'Neill
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT; and
| | - Lillia N Steffenson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT; and
| | - Huong D Meeks
- Utah Population Database, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Alison M Fraser
- Utah Population Database, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Lucas M Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT; and
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT; and
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Daly CA, Graf AR. Kienböck Disease: Clinical Presentation, Epidemiology, and Historical Perspective. Hand Clin 2022; 38:385-392. [PMID: 36244706 DOI: 10.1016/j.hcl.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the now 110 years that have passed since Kienböck first published his seminal description of lunate osteonecrosis, improvements in imaging technology and surgical technique have provided a better understanding of Kienböck disease pathogenesis and treatment. However, the precise etiology, natural history, and optimal treatment remain controversial. Future studies examining the genetics behind the disease and large-scale prospective studies comparing treatment options represent the next step in improving our understanding of this rare and complex phenomenon.
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Affiliation(s)
- Charles Andrew Daly
- Department of Orthopaedic Surgery, Division of Upper Extremity Surgery, Medical University of South Carolina, Medical University of South Carolina Orthopaedics, 96 Jonathan Lucas Street, MSC Code: 708, Charleston, SC 29425, USA.
| | - Alexander Reed Graf
- Department of Orthopedic Surgery, Division of Upper Extremity Surgery, Emory University, Emory Orthopaedics & Spine Center, 21 Ortho Lane, Atlanta, GA 30329, USA.
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Gavile CM, Kazmers NH, Novak KA, Meeks HD, Yu Z, Thomas JL, Hansen C, Barker T, Jurynec MJ. Familial Clustering and Genetic Analysis of Severe Thumb Carpometacarpal Joint Osteoarthritis in a Large Statewide Cohort. J Hand Surg Am 2022; 47:923-933. [PMID: 36184273 PMCID: PMC9547951 DOI: 10.1016/j.jhsa.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Our goals were to identify individuals who required surgery for thumb carpometacarpal (CMC) joint osteoarthritis (OA), determine if CMC joint OA clusters in families, define the magnitude of familial risk of CMC joint OA, identify risk factors associated with CMC joint OA, and identify rare genetic variants that segregate with familial CMC joint OA. METHODS We searched the Utah Population Database to identify a cohort of CMC joint OA patients who required surgery. Affected individuals were mapped to pedigrees to identify high-risk families with excess clustering of CMC joint OA. Cox regression models were used to calculate familial risk of CMC joint OA in related individuals. Risk factors were evaluated using logistic regression models. Whole exome sequencing was used to identify rare coding variants associated with familial CMC joint OA. RESULTS We identified 550 pedigrees with excess clustering of severe CMC joint OA. The relative risk of CMC joint OA requiring surgical treatment was elevated significantly in first- and third-degree relatives of affected individuals, and significant associations with advanced age, female sex, obesity, and tobacco use were observed. We discovered candidate genes that dominantly segregate with severe CMC joint OA in 4 independent families, including a rare variant in Chondroitin Sulfate Synthase 3 (CHSY3). CONCLUSIONS Familial clustering of severe CMC joint OA was observed in a statewide population. Our data indicate that genetic and environmental factors contribute to the disease process, further highlighting the multifactorial nature of the disease. Genomic analyses suggest distinct biological processes are involved in CMC joint OA pathogenesis. CLINICAL RELEVANCE Awareness of associated comorbidities may guide the diagnosis of CMC joint OA in at-risk populations and help identify individuals who may not do well with nonoperative treatment. Further pursuit of the genes associated with severe CMC joint OA may lead to assays for detection of early stages of disease and have therapeutic potential.
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Affiliation(s)
| | | | - Kendra A Novak
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Huong D Meeks
- Huntsman Cancer Institute, Utah Population Database, University of Utah, Salt Lake City, UT
| | - Zhe Yu
- Huntsman Cancer Institute, Utah Population Database, University of Utah, Salt Lake City, UT
| | - Joy L Thomas
- Intermountain Healthcare, Precision Genomics, St. George, UT
| | - Channing Hansen
- Intermountain Healthcare, Biorepository, South Salt Lake City, UT
| | - Tyler Barker
- Department of Orthopaedics, University of Utah, Salt Lake City, UT; Intermountain Healthcare, Precision Genomics, Murray, UT; Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Michael J Jurynec
- Department of Orthopaedics, University of Utah, Salt Lake City, UT; Department of Human Genetics, University of Utah, Salt Lake City, UT.
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Jurynec MJ, Gavile CM, Honeggar M, Ma Y, Veerabhadraiah SR, Novak KA, Hoshijima K, Kazmers NH, Grunwald DJ. NOD/RIPK2 signalling pathway contributes to osteoarthritis susceptibility. Ann Rheum Dis 2022; 81:1465-1473. [PMID: 35732460 PMCID: PMC9474725 DOI: 10.1136/annrheumdis-2022-222497] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/07/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES How inflammatory signalling contributes to osteoarthritis (OA) susceptibility is undetermined. An allele encoding a hyperactive form of the Receptor Interacting Protein Kinase 2 (RIPK2) proinflammatory signalling intermediate has been associated with familial OA. To test whether altered nucleotide-binding oligomerisation domain (NOD)/RIPK2 pathway activity causes heightened OA susceptibility, we investigated whether variants affecting additional pathway components are associated with familial OA. To determine whether the Ripk2104Asp disease allele is sufficient to account for the familial phenotype, we determined the effect of the allele on mice. METHODS Genomic analysis of 150 independent families with dominant inheritance of OA affecting diverse joints was used to identify coding variants that segregated strictly with occurrence of OA. Genome editing was used to introduce the OA-associated RIPK2 (p.Asn104Asp) allele into the genome of inbred mice. The consequences of the Ripk2104Asp disease allele on physiology and OA susceptibility in mice were measured by histology, immunohistochemistry, serum cytokine levels and gene expression. RESULTS We identified six novel variants affecting components of the NOD/RIPK2 inflammatory signalling pathway that are associated with familial OA affecting the hand, shoulder or foot. The Ripk2104Asp allele acts dominantly to alter basal physiology and response to trauma in the mouse knee. Whereas the knees of uninjured Ripk2Asp104 mice appear normal histologically, the joints exhibit a set of marked gene expression changes reminiscent of overt OA. Although the Ripk2104Asp mice lack evidence of chronically elevated systemic inflammation, they do exhibit significantly increased susceptibility to post-traumatic OA (PTOA). CONCLUSIONS Two types of data support the hypothesis that altered NOD/RIPK2 signalling confers susceptibility to OA.
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Affiliation(s)
- Michael J Jurynec
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
- Department of Human Genetics, University of Utah Health, Salt Lake City, Utah, USA
| | - Catherine M Gavile
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Matthew Honeggar
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Ying Ma
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Kendra A Novak
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Kazuyuki Hoshijima
- Department of Human Genetics, University of Utah Health, Salt Lake City, Utah, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - David J Grunwald
- Department of Human Genetics, University of Utah Health, Salt Lake City, Utah, USA
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Tang Y, Wu B, Huang T, Wang H, Shi R, Lai W, Xiang L. Collision of Commonality and Personalization: Better Understanding of the Periosteum. TISSUE ENGINEERING PART B: REVIEWS 2022; 29:91-102. [PMID: 36006374 DOI: 10.1089/ten.teb.2022.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The periosteum is quite essential for bone repair. The excellent osteogenic properties of periosteal tissue make it a popular choice for accelerated osteogenesis in tissue engineering. With advances in research and technology, renewed attention has been paid to the periosteum. Recent studies have shown that the complexity of the periosteum is not only limited to histological features but also includes genetic and phenotypic features. In addition, the periosteum is proved to be quite site-specific in many ways. This brings challenges to the selection of periosteal donor sites. Limited understanding of the periosteum sets up barriers to developing optimal tissue regeneration strategies. A better understanding of periosteum could lead to better applications. Therefore, we reviewed the histological structure, gene expression, and function of the periosteum from both the commonality and personalization. It aims to discuss some obscure issues and untapped potential of periosteum and artificial periosteum in the application, where further theoretical research is needed. Overall, the site-specificity of the periosteum needs to be fully considered in future applications. However, significant further work is needed in relevant clinical trials to promote the further development of artificial periosteum.
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Affiliation(s)
- Yufei Tang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthdontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, China,
| | - Bingfeng Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China,
| | - Tianyu Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China,
| | - Haochen Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China,
| | - Ruijianghan Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China,
| | - Wenli Lai
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthdontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, China,
| | - Lin Xiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No 14th, 3rd section, Renmin South Road, Chengdu, 610041, China, Chengdu, Sichuan Province, China, 610041,
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Kazmers NH, Meeks HD, Novak KA, Yu Z, Fulde GL, Thomas JL, Barker T, Jurynec MJ. Familial Clustering of Erosive Hand Osteoarthritis in a Large Statewide Cohort. Arthritis Rheumatol 2021; 73:440-447. [PMID: 32940959 PMCID: PMC7914133 DOI: 10.1002/art.41520] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/04/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Erosive hand osteoarthritis (OA) is a severe and rapidly progressing subset of hand OA. Its etiology remains largely unknown, which has hindered development of successful treatments. This study was undertaken to test the hypothesis that erosive hand OA demonstrates familial clustering in a large statewide population linked to genealogical records, and to determine the association of potential risk factors with erosive hand OA. METHODS Patients diagnosed as having erosive hand OA were identified by searching 4,741,840 unique medical records from a comprehensive statewide database, the Utah Population Database (UPDB). Affected individuals were mapped to pedigrees to identify high-risk families with excess clustering of erosive hand OA as defined by a familial standardized incidence ratio (FSIR) of ≥2.0. The magnitude of familial risk of erosive hand OA in related individuals was calculated using Cox regression models. Association of potential erosive hand OA risk factors was analyzed using multivariate conditional logistic regression and logistic regression models. RESULTS We identified 703 affected individuals linked to 240 unrelated high-risk pedigrees with excess clustering of erosive hand OA (FSIR ≥2.0, P < 0.05). The relative risk of developing erosive hand OA was significantly elevated in first-degree relatives (P < 0.001). There were significant associations between a diagnosis of erosive hand OA and age, sex, diabetes, and obesity (all P < 0.05). CONCLUSION Familial clustering of erosive hand OA observed in a statewide database indicates a potential genetic contribution to the etiology of the disease. Age, sex, diabetes, and obesity are risk factors for erosive hand OA. Identification of causal gene variants in these high-risk families may provide insight into the genes and pathways that contribute to erosive hand OA onset and progression.
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Affiliation(s)
- Nikolas H. Kazmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108
| | - Huong D. Meeks
- Population Science, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT 84112
| | - Kendra A. Novak
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108
| | - Zhe Yu
- Population Science, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT 84112
| | - Gail L. Fulde
- Intermountain Healthcare, Precision Genomics, St. George, UT 84790
| | - Joy L. Thomas
- Intermountain Healthcare, Precision Genomics, St. George, UT 84790
| | - Tyler Barker
- Intermountain Healthcare, Precision Genomics, Murray, UT 84107
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112
| | - Michael J. Jurynec
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108
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