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Sofia V Krylova, Sara Glickman, Ali Kalam, Katherine Chemakin, Joseph Yi, Linda Forrester, Priti Mishall, Adi Pinkas Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, 10461, USACorrespondence: Adi Pinkas, Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, F620S, Bronx, NY, 10461, USA, Email adi.pinkas@einsteinmed.eduAbstract: The thoracic cavity contains vital cardiovascular and pulmonary structures. Few congenital anatomical variations in the bronchial tree and pulmonary vasculature have been reported. Understanding such variants is crucial during surgical procedures that involve the thorax. During routine dissection of an 89-year-old male cadaver as part of a first-year anatomy course, an anomaly of the bronchial tree was discovered. The left lung hilum was notable for the pulmonary artery being posterior to the mainstem bronchus. The case report describes normal lung development and anatomy and the significance of this novel variation in which has not been previously described in the literature.Keywords: pulmonary artery, bronchus, lung, pulmonary vein, thoracic region

Abstract Background Limited research has explored the effect of Circle of Willis (CoW) anatomy among blunt cerebrovascular injuries (BCVI) on outcomes. It remains unclear if current BCVI screening and scanning practices are sufficient in identification of concomitant COW anomalies and how they affect outcomes. Methods This retrospective cohort study included adult traumatic BCVIs at 17 level I-IV trauma centers (08/01/2017-07/31/2021). The objectives were to compare screening criteria, scanning practices, and outcomes among those with and without COW anomalies. Results Of 561 BCVIs, 65% were male and the median age was 48 y/o. 17% (n = 93) had a CoW anomaly. Compared to those with normal CoW anatomy, those with CoW anomalies had significantly higher rates of any strokes (10% vs. 4%, p = 0.04), ICHs (38% vs. 21%, p = 0.001), and clinically significant bleed (CSB) before antithrombotic initiation (14% vs. 3%, p

The grass subspecie (ssp.) Vulpia ambigua is devoid of long hairs on its stiffly erect and very narrow inflorescence. It exhibits a purplish coloring at fruiting. It is generally smaller in all its parts as compared to the subspecie Vulpa ciliata. A distinctive feature of the ssp. ambigua is the very unequal length of its two glumes. V. ciliata belongs to the Mediterranean-Atlantic portion of the United Kingdom while ssp. ambigua is limited to England, Wales and the Channel Islands.

Ahmad F Bayomy,1 Lynn Ann Forrester,1 Stephen G Crowley,2 Charles A Popkin1 1Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA; 2Department of Orthopedic Surgery, Albany Medical College, Albany, NY, USACorrespondence: Charles A PopkinDepartment of Orthopedic Surgery, Columbia University Medical Center, 3959 Broadway 8 th Floor, New York, NY 10032, USATel +1 (212) 305-4787Email cp2654@cumc.columbia.eduAbstract: The use of eponyms in the orthopedics literature has come under scrutiny, and there is a growing body of literature evaluating the utility of these terms in modern healthcare delivery. Although the field of pediatric orthopedic sports medicine is a relatively modern subspecialty, it is built on a foundation of over 100 years of pediatric musculoskeletal medicine. As a result, eponyms account for a significant portion of the vernacular used in the field. The purpose of this review is to summarize and describe the history of common eponyms relevant to pediatric sports pathology, examination maneuvers, classification systems, and surgical procedures. Use of eponyms in medicine is flawed. However, an improved understanding of these terms allows for informed use in future scientific discourse, patient care and medical education and may encourage future innovation and research into understanding pediatric orthopedic pathologies.Keywords: eponyms, orthopedics, sports medicine, pediatrics, Galeazzi, Greulich, Pyle, Beighton, Horan, apophysitis

What is known and objective Clostridium difficile infection ( CDI) represents a spectrum of disease and is a significant concern for healthcare institutions. Our study objective was to assess whether implementation of a regional CDI management policy with Clinical Pharmacy and Medical Microbiology and Infection Control involvement would lead to an improvement in concordance in prescribing practices to an evidence-based CDI disease severity assessment and pharmacological treatment algorithm. Methods Conducted at a tertiary care teaching hospital, this two-phase quality assurance study consisted of a baseline retrospective healthcare record review of patients with CDI prior to the implementation of a regional CDI management policy followed by a prospective evaluation post-implementation. Results and discussion One hundred and forty-one CDI episodes in the pre-implementation group were compared to 283 episodes post-implementation. Overall treatment concordance to the CDI treatment algorithm was achieved in 48 of 141 cases (34%) pre-implementation compared with 136 of 283 cases (48·1%) post-implementation ( P = 0·01). The median time to treatment with vancomycin was reduced from five days to one day ( P < 0·01), with median length of hospital stay decreasing from 30 days to 21 days ( P = 0·01) post-implementation. There was no difference in 30-day all-cause mortality. What is new and conclusion A comprehensive approach with appropriate stakeholder involvement in the development of clinical pathways, education to healthcare workers and prospective audit with intervention and feedback can ensure patients diagnosed with CDI are optimally managed and prescribed the most appropriate therapy based on CDI disease severity. [ABSTRACT FROM AUTHOR]

Summary Background Pre-operative decolonization therapy (DcTx) using chlorhexidine (CHG) body washes and/or intranasal mupirocin can reduce surgical site infections (SSIs), but compliance is often suboptimal. Aim To assess the effectiveness of immediate DcTx using a novel approach of intranasal antimicrobial photodisinfection therapy (PDT) combined with CHG body wipes for the reduction of SSIs. Methods Between 1 st September 2011 and 31 st August 2012, 3068 elective cardiac, orthopaedic, spinal, vascular, thoracic and neurosurgical patients were treated with CHG in the 24 h preceding surgery, and received intranasal PDT in the pre-operative area. SSI surveillance methodology remained unchanged from previous years and patients were followed for one year. Results were compared with those for a four-year historical control group of 12,387 patients as well as those for a concurrent control group of 206 untreated patients. Findings A significant reduction in the SSI rate was observed between treated patients and the historical control group [1.6% vs 2.7%, P = 0.0004, odds ratio (OR) 1.73, 95% confidence interval (CI) 1.2815–2.3453]. This significant reduction was maintained on intent-to-treat analysis ( P = 0.021, OR 1.37, 95% CI 1.9476–1.7854). Overall compliance with DcTx was 94%. A 1:4 propensity score analysis of matched treated and untreated patients demonstrated that DcTx reduced the risk of SSIs significantly ( P = 0.00026, z = 3.65). Conclusion The combination of CHG wipes and PDT immediately before surgery reduced SSIs, achieved excellent compliance, and was easily integrated into the pre-operative routine. [ABSTRACT FROM AUTHOR]

Summary: Data on healthcare workers''(HCWs) self-reported knowledge regarding selection of facial protection equipment, usage preferences and compliance are limited. We used a questionnaire on the use of facial protection equipment at a 700-bed adult tertiary care hospital employing approximately 7000 HCWs. Clinical areas targeted were those with frequent users of N95 respirators: intensive care unit, emergency room, respiratory services, and internal medicine. Respiratory therapists were also invited. In all, 137 questionnaires (68.5%) were returned. Most (72.8%) reported that training on the use of facial protection equipment was ‘sufficient’ to ‘excellent’. The PFR95 and 3M 1860 Cone were used most frequently (56%) followed by the 3M 1870 Pocket (42%). While 95% reported having been fit-tested, only 60% were tested annually. PRF95 use exceeded the number of HCWs fit-tested for the item. Overall comfort and compliance scores were 13.6/20 and 21.5/25, respectively, for respirators and 7.7/10 and 18.5/25 for protective eyewear. No relationship between comfort and years of use of either respirators or protective eyewear was found. The results highlight potential failures in effectiveness in the use of personal protective equipment that could compromise HCW safety, and support observations that compliance in the workplace is usually less than in the research setting. [Copyright &y& Elsevier]

The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects had impaired temporal and spatial gait characteristics compared to non-PAD controls at preferred and rapid self-selected walking paces. A total of 28 PAD subjects with intermittent claudication (age = 71 ± 1; mean ± SEM) and 15 non-PAD controls with at least one cardiovascular risk factor but no ambulatory leg pain (age = 71 ± 1) were recruited. Gait parameters consisting of velocity, cadence, stride length, swing time, stance time, single-support time, double-support time, and base of support were recorded at the preferred and rapid walking paces. At the rapid walking pace, velocity was 22% slower ( p, 0.001) in the PAD subjects compared with the non-PAD controls (99.9 ± 3.3 vs. 117.5 ± 5.3 cm/s) due to an 8% ( p= 0.019) slower cadence (99.9 ± 1.7 vs. 103.3 ± 2.4 steps/min) and a 14% ( p, 0.001) shorter stride length (119.8 ± 2.9 vs. 135.8 ± 4.2 cm/stride). The PAD subjects spent 5% less of the gait cycle in the swing phase ( p= 0.006) and 3% more in stance ( p= 0.006) than their non-PAD counterparts. During the stance phase, the PAD subjects spent 5% less of the gait cycle in single-stance ( p= 0.004) and 16% more in double-stance ( p= 0.007). Similar results were obtained at the preferred walking pace. In conclusion, compared with the controls, PAD subjects adopted an ambulatory pattern that favored greater gait stability at the expense of greater walking speed at either their preferred or rapid self-selected paces. [ABSTRACT FROM AUTHOR]

Interrogative suggestibility refers to the tendency of individuals to accept suggestive information in an interrogative context. Within the criminal justice system, this factor has substantial implications in relation to the obtaining of written statements, admissions from suspects, and, most importantly, false confessions. Gudjonsson and Clark (1986) have developed a theoretical model of suggestibility, and contend that suggestibility is mediated by an individual's cognitive abilities, mental state and personality characteristics. In particular, they emphasise the role of coping strategies, positing that active/problem‐focused coping strategies lead to greater resistance to suggestive information whilst avoidant/emotion‐focused strategies lead to increased susceptibility to accepting suggestive information. The current study evaluated this aspect of Gudjonsson and Clark's (1986) model, using the Gudjonsson Suggestibility Scale (Gudjonsson, 1984) and the COPE (Carver, Scheier & Weintraub, 1989) inventory. Additionally, it was evaluated whether dispositional or situational coping strategies would be a better predictor of interrogative suggestibility. Sixty‐one participants completed both measures in the belief that they were participating in an investigation into memory. The results failed to support the hypothesized relationship between methods of coping and levels of interrogative suggestibility. Additionally, neither situational nor dispositional coping strategies were found to better predict interrogative suggestibility. The results are discussed in terms of Gudjonsson's (1988) previous findings and current theories on coping behaviour. [ABSTRACT FROM PUBLISHER]

The nucleotide sequence of the Escherichia coli enterobactin biosynthesis gene entD has been determined. entD specifies a predicted 23579 Dalton protein containing several helical regions, a transmembrane segment and one positively charged domain. The EntD polypeptide was overexpressed and identified in electrophoretic gels as a membrane protein. Although results of conventional membrane fractionation techniques were inconclusive, protease accessibility studies provided evidence that EntD domains are exposed on the inner leaflet of the cytoplasmic membrane. The presence of repetitive extragenic palindromic (REP) sequences within the fepA-entD intercistronic region was confirmed. Lack of a canonical promoter and an iron control region 5′ to entD, along with RNA hybridization data, suggest that an iron-regulated transcript contains both fepA and entD. [ABSTRACT FROM AUTHOR]

One target for rehabilitating locomotor disorders in older adults is to increase mobility by improving walking velocity. Combining rhythmic auditory cueing (RAC) and treadmill training permits the study of the stride length/stride velocity ratio (SL/SV), often reduced in those with mobility deficits. We investigated the use of RAC to increase velocity by manipulating the SL/SV ratio in older adults. Nine participants (6 female; age: 61.1 ± 8.8 years) walked overground on a gait mat at preferred and fast speeds. After acclimatization to comfortable speed on a treadmill, participants adjusted their cadence to match the cue for 3 min at 115% of preferred speed by either (a) increasing stride length only or (b) increasing stride frequency only. Following training, participants walked across the gait mat at preferred velocity without, and then with, RAC. Group analysis determined no immediate overground velocity increase, but reintroducing RAC did produce an increase in velocity after both conditions. Group and single subject analysis determined that the SL/SV ratio changed in the intended direction only in the stride length condition. We conclude that RAC is a powerful organizer of gait parameters, evidenced by its induced after-effects following short duration training. [ABSTRACT FROM AUTHOR]

The ability to differentiate genetically modified mouse embryonic stem (ES) cells into functional macrophages provides a potentially attractive resource to study host-pathogen interactions without the need for animal experimentation. This is particularly useful in instances where the gene of interest is essential and a knockout mouse is not available. Here we differentiated mouse ES cells into macrophages in vitro and showed, through a combination of flow cytometry, microscopic imaging, and RNA-Seq, that ES cell-derived macrophages responded to S. Typhimurium, in a comparable manner to mouse bone marrow derived macrophages. We constructed a homozygous mutant mouse ES cell line in the Traf2 gene that is known to play a role in tumour necrosis factor-α signalling but has not been studied for its role in infections or response to Toll-like receptor agonists. Interestingly, traf2-deficient macrophages produced reduced levels of inflammatory cytokines in response to lipopolysaccharide (LPS) or flagellin stimulation and exhibited increased susceptibility to S. Typhimurium infection. [ABSTRACT FROM AUTHOR]

Abstract Background Hemiparesis after stroke often leads to impaired ankle motor control that impacts gait function. In recent studies, robotic devices have been developed to address this impairment. While capable of imparting forces to assist during training and gait, these devices add mass to the paretic leg which might encumber patients' gait pattern. The purpose of this study was to assess the effects of the added mass of one of these robots, the MIT's Anklebot, while unpowered, on gait of chronic stroke survivors during overground and treadmill walking. Methods Nine chronic stroke survivors walked overground and on a treadmill with and without the anklebot mounted on the paretic leg. Gait parameters, interlimb symmetry, and joint kinematics were collected for the four conditions. Repeated-measures analysis of variance (ANOVA) tests were conducted to examine for possible differences across four conditions for the paretic and nonparetic leg. Results The added inertia and friction of the unpowered anklebot had no statistically significant effect on spatio-temporal parameters of gait, including paretic and nonparetic step time and stance percentage, in both overground and treadmill conditions. Noteworthy, interlimb symmetry as characterized by relative stance duration was greater on the treadmill than overground regardless of loading conditions. The presence of the unpowered robot loading reduced the nonparetic knee peak flexion on the treadmill and paretic peak dorsiflexion overground (p < 0.05). Conclusions Our results suggest that for these subjects the added inertia and friction of this backdriveable robot did not significantly alter their gait pattern.

Abstract Background The rodent specific reproductive homeobox (Rhox) gene cluster on the X chromosome has been reported to contain twelve homeobox-containing genes, Rhox1-12. Results We have identified a 40 kb genomic region within the Rhox cluster that is duplicated eight times in tandem resulting in the presence of eight paralogues of Rhox2 and Rhox3 and seven paralogues of Rhox4. Transcripts have been identified for the majority of these paralogues and all but three are predicted to produce full-length proteins with functional potential. We predict that there are a total of thirty-two Rhox genes at this genomic location, making it the most gene-rich homoeobox cluster identified in any species. From the 95% sequence similarity between the eight duplicated genomic regions and the synonymous substitution rate of the Rhox2, 3 and 4 paralogues we predict that the duplications occurred after divergence of mouse and rat and represent the youngest homoeobox cluster identified to date. Molecular evolutionary analysis reveals that this cluster is an actively evolving region with Rhox2 and 4 paralogues under diversifying selection and Rhox3 evolving neutrally. The biological importance of this duplication is emphasised by the identification of an important role for Rhox2 and Rhox4 in regulating the initial stages of embryonic stem (ES) cell differentiation. Conclusion The gene rich Rhox cluster provides the mouse with significant biological novelty that we predict could provide a substrate for speciation. Moreover, this unique cluster may explain species differences in ES cell derivation and maintenance between mouse, rat and human.