A Multi-center Simulation-Based Emergency Medicine Resident Boot Camp Can Improve Teamwork, Communication, and Clinical Skills.

Boot camps are designed to deliver highly specific education in a short amount of time. Educational boot camps are known to improve confidence in clinical capabilities and medical knowledge and promote teamwork skills. We created an emergency medicine (EM) boot camp with targeted learning objectives based on expected mastery of post-graduate year (PGY)-level educational objectives based on the Accreditation Council for Graduate Medical Education (ACGME) EM milestones. This boot camp included a qualitative assessment, survey-based feedback, and quantitative assessment, which included the team's performance utilizing a validated code team checklist (Cardiac Code Management Assessment Tool). After attending the conference, EM residents felt more confident in achieving the EM ACGME milestones including the ability to provide immediate interventions to a critical patient, effective use of team communication, the ability to switch tasks efficiently, and to provide real-time feedback to their team. Eighty-six percent of residents preferred this teaching modality over other conference-based didactics and would like to see greater incorporation of similar interventions in future conferences.

Epiploic Appendagitis Mimicking Acute Appendicitis: An Osteopathic Case Report.

Acute epiploic appendagitis is a rare cause of abdominal pain, often misdiagnosed as acute appendicitis or diverticulitis given similar clinical presentation and findings. The treatment is supportive care and is typically self-limited. The osteopathic structural exam can give insight into pathology and in this case, was suggestive of a non-appendiceal origin of her pain, in which emergent surgery could be avoided. Requiring computerized tomography to identify, acute epiploic appendagitis is a rare cause of abdominal pain and should be considered in the differential diagnosis.

Challenges in the Diagnosis of Brodie's Abscess in Subacute Osteomyelitis.

INTRODUCTION: Subacute osteomyelitis (OM) is a difficult condition to diagnose and treat, further complicated with an atypical presentation of a Brodie's abscess (BA). BA is typically seen in pediatric, male populations, with minimal incidence in adult populations. Concern for malignancy and cold abscess can preempt oncological work-up. Duration of symptoms and radiological findings are often helpful but may not always match known classical findings. CASE REPORT: Here we present a case of subacute OM in a 30-year-old Japanese male with a distant medical history of OM as a child with a subsequent review of Brodie's versus cold abscesses in the context of an atypical, asymptomatic presentation. CONCLUSION: Clinical history and suspicion can be crucial to determine the presence of a BA in comparison to a cold abscess in the context of subacute OM. Crossing multiple disciplines from primary care and emergency treatment to orthopedic and oncological surgery, providers must be aware of atypical presentations of OM. Recurrence is unlikely with correct diagnosis and adequate surgical debridement and antibiotics, which, in turn, can improve patient outcomes and decrease unnecessary testing.

Direct quantification of gamma H2AX by cell-based high throughput screening for evaluation of genotoxicity of pesticides in a human thyroid cell lines.

Genotoxicity is thought to be the cause of many cancers. Genotoxicity due to environmental toxins may be partly responsible for the dramatic increase in the incidence of papillary thyroid cancer over the past two decades. Here, we present a fully automatable assay platform that directly quantifies the phosphorylation of nuclear histone gamma H2AX (γH2AX), a specific cellular marker for DNA double strand breaks (DSBs) via immunohistochemistry and laser scanning cytometry. It multiplexes γH2AX with total cell number measured as propidium iodide and calculates the percentage of cells with DSBs. Validation of this assay using NTHY-ori-3-1 human thyroid cells and etoposide showed that it was an excellent choice for high throughput applications. We used the assay to test the genotoxic effects of the EPA Toxcast Phase 1 pesticide library of 309 compounds. Compounds were evaluated in dose response and the DSB was quantified. We found that 19 pesticides induce DSB in vitro, highlighting a need to further assess these pesticides for their long-term oncogenic effects on the thyroid gland. Environ. Mol. Mutagen. 58:522-528, 2017. © 2017 Wiley Periodicals, Inc.

Recent advances in animal and human pluripotent stem cell modeling of cardiac laminopathy.

Laminopathy is a disease closely related to deficiency of the nuclear matrix protein lamin A/C or failure in prelamin A processing, and leads to accumulation of the misfold protein causing progeria. The resultant disrupted lamin function is highly associated with abnormal nuclear architecture, cell senescence, apoptosis, and unstable genome integrity. To date, the effects of loss in nuclear integrity on the susceptible organ, striated muscle, have been commonly associated with muscular dystrophy, dilated cardiac myopathy (DCM), and conduction defeats, but have not been studied intensively. In this review, we aim to summarize recent breakthroughs in an in vivo laminopathy model and in vitro study using patient-specific human induced pluripotent stem cells (iPSCs) that reproduce the pathophysiological phenotype for further drug screening. We describe several in-vivo transgenic mouse models to elucidate the effects of Lmna H222P, N195K mutations, and LMNA knockout on cardiac function, in terms of hemodynamic and electrical signal propagation; certain strategies targeted on stress-related MAPK are mentioned. We will also discuss human iPSC cardiomyocytes serving as a platform to reveal the underlying mechanisms, such as the altered mechanical sensation in electrical coupling of the heart conduction system and ion channel alternation in relation to altered nuclear architecture, and furthermore to enable screening of drugs that can attenuate this cardiac premature aging phenotype by inhibition of prelamin misfolding and oxidative stress, and also enhancement of autophagy protein clearance and cardiac-protective microRNA.