A Communicating Branch Between the Musculocutaneous Nerve and the Median Nerve: A Case Report

Anatomical variations of peripheral nerves are commonly reported in the literature.  While typically benign, they are of clinical importance as they can contribute to atypical clinical presentations, cause difficulty with imaging and nerve conduction studies, and lead to surgical challenges for surgeons.  We report here a communicating branch between the musculocutaneous nerve and median nerve found during cadaveric dissection in a Doctor of Nursing Practice course in the Department of Nurse Anesthesia at Samford University.  Although the case described here is among the most common anatomical variations of the peripheral nerves, there are classification systems for this variation that need to be recognized and applied by anatomists, clinicians, and surgeons

Bilateral Long Head of the Triceps Brachii Muscle Innervation via Axillary Nerve: A Case Report

The radial nerve has traditionally been considered the innervation of the long head of the triceps brachii (LHT). However, cadaveric studies have discovered LHT innervation via the axillary nerve in roughly 6-15 % of shoulders. A cadaver with exclusive axillary nerve innervation to the LHT bilaterally was discovered during cadaveric dissection in a graduate course at Samford University. This anatomical variation may have clinical implications for surgeries, shoulder dislocations, and quadrilateral space syndrome. Axillary nerve injuries may additionally present with shoulder extension and elbow extension weakness if this variation is present.&nbsp

Reductions in all-cause, cancer, and coronary mortality in statin-treated patients with heterozygous familial hypercholesterolaemia: a prospective registry study

AIMS: To examine the changes in coronary, all-cause, and cancer mortality in patients with heterozygous familial hypercholesterolaemia (FH) before and after lipid-lowering therapy with statins. METHODS AND RESULTS: A total of 3382 patients (1650 men) aged <80 years were recruited from 21 lipid clinics in the United Kingdom and followed prospectively between 1980 and 2006 for 46 580 person-years. There were 370 deaths, including 190 from coronary heart disease (CHD) and 90 from cancer. The standardized mortality ratio (compared with the population in England and Wales) was calculated before and from 1 January 1992. In patients aged 20-79 years, CHD mortality fell significantly by 37% (95% CI = 7-56) from 3.4- to 2.1-fold excess. Primary prevention resulted in a 48% reduction in CHD mortality from 2.0-fold excess to none, with a smaller reduction of nearly 25% in patients with established disease. Coronary mortality was reduced more in women than in men. In patients without known CHD at registration, all-cause mortality from 1992 was 33% (21-43), lower than in the general population, mainly due to a 37% (21-50) lower risk of fatal cancer. CONCLUSION: The results emphasize the importance of early identification of FH and treatment with statins

Sex differences in cardiovascular morbidity associated with familial hypercholesterolaemia: A retrospective cohort study of the UK Simon Broome register linked to national hospital records

Background and aims: The UK Simon Broome (SB) familial hypercholesterolaemia (FH) register previously reported 3-fold higher standardised mortality ratio for cardiovascular disease (CVD) in women compared to men from 2009 to 2015. Here we examined sex differences in CVD morbidity in FH by national linkage of the SB register with Hospital Episode Statistics (HES).Methods: Of 3553 FH individuals in the SB register (aged 20-79 years at registration), 2988 (52.5% women) had linked HES records. Standardised Morbidity Ratios (SMbR) compared to an age and sex-matched UK general practice population were calculated [95% confidence intervals] for first CVD hospitalisation in HES (a composite of coronary heart disease (CHD), myocardial infarction (MI), stable or unstable angina, stroke, TIA, peripheral vascular disease (PVD), heart failure, coronary revascularisation interventions).Results: At registration, men had significantly (p50 years, SMbR was 33% higher in women than men (6.11 [5.57-6.70] vs 4.59 [4.08-5.15]).Conclusions: Excess CVD morbidity due to FH remains markedly elevated in women at all ages, but especially those aged 30-50 years. This highlights the need for earlier diagnosis and optimisation of lipid-lowering risk factor management for all FH patients, with particular attention to young women with FH

The genetic and clinico-pathological profile of early-onset progressive supranuclear palsy

BACKGROUND: Studies on early-onset presentations of progressive supranuclear palsy (PSP) have been limited to those where a rare monogenic cause has been identified. Here, we have defined early-onset PSP (EOPSP) and investigated its genetic and clinico-pathological profile in comparison with late-onset PSP (LOPSP) and Parkinson's disease (PD). METHODS: We included subjects from the Queen Square Brain Bank, PROSPECT-UK study, and Tracking Parkinson's study. Group comparisons of data were made using Welch's t-test and Kruskal-Wallis analysis of variance. EOPSP was defined as the youngest decile of motor age at onset (≤55 years) in the Queen Square Brain Bank PSP case series. RESULTS: We identified 33 EOPSP, 328 LOPSP, and 2000 PD subjects. The early clinical features of EOPSP usually involve limb parkinsonism and gait freezing, with 50% of cases initially misdiagnosed as having PD. We found that an initial clinical diagnosis of EOPSP had lower diagnostic sensitivity (33%) and positive predictive value (38%) in comparison with LOPSP (80% and 76%) using a postmortem diagnosis of PSP as the gold standard. 3/33 (9%) of the EOPSP group had an underlying monogenic cause. Using a PSP genetic risk score (GRS), we showed that the genetic risk burden in the EOPSP (mean z-score, 0.59) and LOPSP (mean z-score, 0.48) groups was significantly higher (P < 0.05) when compared with the PD group (mean z-score, -0.08). CONCLUSIONS: The initial clinical profile of EOPSP is often PD-like. At the group level, a PSP GRS was able to differentiate EOPSP from PD, and this may be helpful in future diagnostic algorithms. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society

Astroparticle Physics with a Customized Low-Background Broad Energy Germanium Detector

The MAJORANA Collaboration is building the MAJORANA DEMONSTRATOR, a 60 kg array of high purity germanium detectors housed in an ultra-low background shield at the Sanford Underground Laboratory in Lead, SD. The MAJORANA DEMONSTRATOR will search for neutrinoless double-beta decay of 76Ge while demonstrating the feasibility of a tonne-scale experiment. It may also carry out a dark matter search in the 1-10 GeV/c^2 mass range. We have found that customized Broad Energy Germanium (BEGe) detectors produced by Canberra have several desirable features for a neutrinoless double-beta decay experiment, including low electronic noise, excellent pulse shape analysis capabilities, and simple fabrication. We have deployed a customized BEGe, the MAJORANA Low-Background BEGe at Kimballton (MALBEK), in a low-background cryostat and shield at the Kimballton Underground Research Facility in Virginia. This paper will focus on the detector characteristics and measurements that can be performed with such a radiation detector in a low-background environment.Comment: Submitted to NIMA Proceedings, SORMA XII. 9 pages, 4 figure

Effects of Tylosin Administration Routes on the Development of Antimicrobial Resistance in Fecal Enterococci of Finishing Swine

Antibiotics can be administered via various routes in pigs, which may influence antimicrobial resistance development. A total of 40 barrows and 40 gilts (Line 600 × 241; DNA, Columbus, NE; initially 207 ± 7.9 lb) were used in a 35-d trial to determine the effects of tylosin administration route on pig growth performance and development of antimicrobial resistance in fecal Enterococcus spp. isolates. Pens of pigs (1 pig/ pen, 20 pigs/treatment) were blocked by initial body weight (BW) and gender. Within blocks, pens were randomly allotted to 1 of 4 treatments. The antibiotic treatments followed US label directions and were: 1) no antibiotic (Control); 2) 110 mg tylosin per kg of feed for 21 d (Feed); 3) 8.82 mg tylosin per kg of BW through intramuscular injection twice daily for the first 3 d of each wk during the 3-wk treatment period (Injection); and 4) 66 mg of tylosin per liter of drinking water for the first 3 d of each wk during treatment period (Water). Treatments were offered during d 0 to 21, after which all pigs were fed a common diet with no antibiotic until d 35. Fecal samples were collected on d 0, 21, and 35. No evidence for route × gender interactions (P \u3e 0.55) were observed for any growth responses. From d 0 to 21, control pigs and pigs fed medicated feed had greater (P \u3c 0.05) average daily gain (ADG) than those that received injected tylosin, with the ADG of pigs receiving tylosin through the water intermediate. There was no evidence for different average daily feed intake (ADFI) among treatment groups. Pigs that received tylosin through injection or water had poorer (P \u3c 0.05) feed efficiency (F/G) compared with control pigs, but there was no evidence for difference from pigs receiving tylosin through feed. Among the medicated pigs, total tylosin dose administered was the greatest through injection, second highest through feed, with the water medication route the lowest. No evidence for route × day interactions (P \u3e 0.23) were observed for the development of bacterial resistance to any antibiotics. Enterococcal isolates collected from pigs receiving tylosin via feed or injection were more resistant (P \u3c 0.05) to erythromycin and tylosin compared with control pigs and those that received tylosin through water. The estimated probability of antimicrobial resistance to these 2 antibiotics was greater on d 21 and 35 than d 0. In summary, tylosin injection resulted in poorer ADG and F/G of finishing pigs, likely due to stress associated with handling and injection. Tylosin administration through injection and feed resulted in greater probability of enterococcal resistance to erythromycin and tylosin compared with in-water treatment, which is likely a combined effect of administration route and dosage