Anatomy of the interchondral joints and the effects on mobility of ribs.

BACKGROUND: Variations in the anatomy of the anterior rib cage and costal margin have been observed. We sought to evaluate the location of interchondral joints and evaluate their effect on mobility of the rib cage. METHODS: Cadaveric dissections were performed to evaluate the anatomy of the anterior ribs and the composition of the costal margin. Experienced chest wall surgeons and anatomists evaluated this anatomy through a standardized dissection and assessment. The presence of interchondral joints, and morphology and mobility of ribs were quantified. In addition, the movement and interactions of the ribs with upward pressure on the costal margin at the tip of the 10th rib were assessed. RESULTS: Twenty-eight cadavers were evaluated bilaterally. In all patients, the first rib attached to the manubrium, the second rib attached to the sternal/manubrial junction, and ribs 3 to 6 attached directly to the sternum. Interchondral joints were present between ribs 4/5 in 0%, 5/6 in 35%, 6/7 in 96%, and 7/8 in 96%. The eighth/ninth ribs had free tips in 58% and 92%, respectively, and 10th rib was floating in 46%. Upward pressure on the costal margin resulted in compression of the ribs up to, on average, the 5.7 ± 0.6 rib with no compression above this level. This level corresponded to the rib interspace just above the most superior interchondral joint in 98% of evaluation. The transmission of these upward forces demonstrated an articulation of the ribs at the costal cartilage-sternal junction in the lower ribs. CONCLUSION: Bridging interchondral joints are common between ribs 5 to 8 and participate in distributing forces from the costal margin across the chest wall. Upward forces at the costal margin are transmitted across the lower rib cage and result in increased mobility of the lower half of the ribs. The eighth/ninth ribs often have mobile tips, and the 10th is often a floating rib. LEVEL OF EVIDENCE: Diagnostic Test; Level II.

Urinary 2- to 16α-hydroxyestrone ratio did not change with cruciferous vegetable intake in premenopausal women.

The mass ratio of urinary 2-hydroxyestrone to 16-α-hydroxyestrone (2:16) is hypothesized as a biomarker of breast cancer risk in premenopausal women, with higher ratios being theoretically protective. Cruciferous vegetable intake has been associated with higher urinary 2:16 in some studies. We investigated whether a whole-food supplement made from dried Brussels sprouts and kale would increase urinary 2:16 in comparison with placebo or cruciferous vegetables in women. This randomized, parallel arm, placebo-controlled, partly blinded study included 78 healthy premenopausal women (38-50 y) with screening urinary 2:16 ≤3.0. Subjects received either six capsules containing 550 mg dried Brussels sprouts and kale per capsule, 40 g daily alternating broccoli or Brussels sprouts, or placebo for eight weeks. Urinary 2:16 and creatinine were measured at baseline, four, and eight weeks. Intent-to-treat repeated measures-ANOVA with multiple imputation (n=100) for missing values identified no treatment effect (P=0.9) or treatment-by-time interaction (P=0.6); however, a significant time effect was noted (P=0.02). Per-protocol analyses including complete cases found no treatment effect (P=1) or treatment-by-time interaction (P=0.6); however, the significant time effect remained (P=0.03). Restricting analysis to subjects with >80% compliance maintained the time effect (P=0.02). Using Pearson correlations, android-pattern and android:gynoid fat were predictive of change (P≤0.05). In conclusion, neither cruciferous supplements nor an added vegetable serving altered urinary 2:16 in premenopausal women with eight weeks treatment. This ratio did vary with time, which is important for designing future trials.

Assessment of Interpretation Modality and Patient Comprehension in Spanish-speaking Limited English Proficiency (LEP) Patients Presenting to the Emergency Department.

BACKGROUND: Provider-patient language discrepancies with limited English proficiency (LEP) patients can lead to misunderstandings about diagnoses and follow-up care. OBJECTIVES: To assess interpretation modalities used in the emergency department (ED) in terms of patient satisfaction and understanding of discharge diagnosis. METHODS: Spanish-speaking LEP patients completed a survey assessing overall satisfaction and discharge diagnosis comprehension. Modalities included in-person (interpreter or physician/nurse), remote (phone or video), or combination. Differences in proportions with correctly identified diagnoses were compared by modality using Fisher's exact test. RESULTS: Patients preferred a Spanish-speaking staff member (52%) or in-person interpreter (33%) over other modalities. Almost 74% of surveyed patients accurately described their discharge diagnosis. Diagnostic accuracy was increased among patients using remote modalities alone compared with in-person alone or combination (p=.02). CONCLUSION: Taking into account patient preferences and diagnostic accuracy, this study suggests the utility of having different interpreter modalities available for Spanish-speaking LEP ED patients.