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, those who experienced more frequent racial discrimination in the present study) may experience a systematic disadvantage in cancer communication. A more careful consideration of cultural, racial, and ethnic differences in metaphor use may be a crucial step towards reducing cancer disparities.Antimicrobial resistance (AMR) is widely perceived as a threat to human and animal health and a significant One Health issue with extensive and complex factors contributing to its occurrence and spread. Previous studies have surveyed human and animal health professionals to determine their perceptions regarding AMR and antimicrobial use (AMU). There are limited studies exploring the understanding of veterinary students despite their critical role as future antimicrobial prescribers. A cross-sectional survey was administered to an entire cohort of Doctor of Veterinary Medicine Year 2 (DVM2) students (n = 136) to investigate their knowledge and perceptions regarding AMR and AMU prior to formal education on this issue. Ninety students (66.2% of the cohort) completed the survey. There was overwhelming agreement regarding the immediacy of the problem, with 84.4% of students indicating that 'We must take action on AMR'. Despite more than 94.4% of students correctly defining AMR, specific knowledge regarding AMR imp AMU, as well as prescribers' personal contribution to AMR perpetuation and amelioration.Immune checkpoint inhibitors are a new class of oncologic drugs that act via the inhibition of checkpoints, thereby unlocking the immune system to attack cancer cells. Their emergence has radically changed the concept of therapy in oncologic patients. However, despite their overall favorable profile, their use has been associated with specific toxicities that may potentially affect treatment. The so-called immune-related adverse events (irAEs) mostly correspond to dysimmune reactions that can affect nearly every organ system, in theory, notably with the development of colitis, hepatitis, pneumonitis, or thyroiditis. Dermatologic irAEs are also among the most common, reaching a rate of approximately 40%. They are characterized by a wide phenotypic range, including mainly eczematous or lichenoid rashes, psoriasis, or autoimmune bullous disorders. Pruritus may accompany the aforementioned rashes or develop as an isolated symptom without the presence of skin changes. Depigmentation and hair/nail changes can be also observed in association with immune checkpoint inhibitor treatment. In the current article, we present an overview of the clinical spectrum of irAEs and provide tips for early recognition and management of dermatologic irAEs. We highlight the role that dermatologists can play in relieving patients and allowing for oncologic treatment to be maintained and administered more safely.Lower urinary tract symptomatology is often difficult to categorize if history and investigation focus only on the urinary tract. Disease and dysfunction in organs more posteriorly can often cause or influence such bladder and urethral symptoms. Vulvovaginal skin diseases are an important but often missed influence on lower urinary tract symptomatology.There have been a number of advances in the clinical and translational understanding of cutaneous lupus and dermatomyositis, which both disproportionately affect women. These advances have involved ongoing collaborations between dermatology and rheumatology that highlight the importance of the skin in these disorders, with improvement in the education of trainees and clinical management of these complex multisystem diseases. In addition, a new disease classification has allowed inclusion of patients with skin-predominant dermatomyositis, frequently associated with systemic findings, in the spectrum of idiopathic inflammatory myopathies. Validated outcome measures allow translational research and facilitate progress toward better and more targeted therapeutics. Clinical trials using disease severity tools, such as the Cutaneous Lupus Erythematosus Area and Severity Index and the Cutaneous Dermatomyositis Disease Area and Severity Index, allow measurement of improvement in the skin. Recent results of phase 2 and 3 trials clearly show that patients will benefit from collaborative interactions and studies between dermatology and rheumatology.The gut microbiome plays a critical role in developing and educating our immune system. Therefore, its now well-established role in autoimmunity and immune disorders is in some ways not surprising. However, it is well-documented in the literature that there is a female predisposition to autoimmune disorders, while sexual dimorphisms in the human microbiome have been confined largely to areas outside of the gut. Herein, we will review the evidence of sexual dimorphism in the gut microbiome in both mice and humans, how this differs in animal models versus humans, and how such dimorphisms may be established and influenced by both host and environmental factors. We will conclude with a discussion on how these aspects of the gut microbiome may contribute to both the study and pathogenesis of gender-specific autoimmunity and immune disorders.Dermatology is often tasked with balancing the clinical appearance of aging skin with the reality of what healthy aging means. In this article, we review some of the core principles of healthy aging and explore common misconceptions, both from patients and physicians, regarding aging. Recognition of the basics of healthy aging and awareness of these aging myths can empower providers to advise patients accurately and productively regarding their aging goals.A young male presented to a nearby hospital with a left shoulder dislocation after an alleged kickboxing injury. The patient reported worrying clinical findings including excruciating pain and absent sensation distally. Reduction was successful but his shoulder re-dislocated shortly after. His reported symptoms worsened and he was transferred to our institution. Imaging findings were not immediately concerning and he went to theatre the next day for an examination under anaesthetic. His shoulder was re-located easily and an immobiliser applied. Less than an hour later, the patient managed to re-dislocate his shoulder in recovery. He was subjected to another general anaesthetic and successful reduction. He absconded the following day after being declined multiple and increasing doses of opioid analgesia. He re-presented three weeks later with similar clinical findings but a different mechanism of injury. Further exploration of his collateral history revealed that he had been using a false identity. He had presented to all hospitals in our city within the previous 6 months. Once confronted, he did not return to these hospitals. He was also capable of self-relocating his shoulder. This case bore a striking resemblance to a case described by Warren in 2000 of a young lady with an apparently dislocated shoulder presenting to multiple city hospitals looking for analgesia and general anaesthetics. We wished to highlight the diagnostic and ethical challenges associated with these patients. They are vulnerable and so a high index of clinical suspicion is needed on the part of the surgeon to avoid unnecessary interventions. Effective communication between orthopaedic departments is a key recommendation from this case to mitigate risk of harm to these patients.Delayed presentation of penetrating cardiac injuries is exceedingly rare due to the observed near 100% pre-hospital mortality. We describe a case of a patient who presented for evaluation nearly 24 h after sustaining a self-inflicted pneumatic nail gun injury to the right ventricular outflow tract. Remarkably, the patient had no evidence of hemodynamic compromise. This case highlights the importance of maintaining a high index of suspicion for cardiac injury with penetrating trauma to the cardiac box regardless of presenting signs and symptoms, and the value of adhering to advanced trauma life support principles.Flail chest is a common injury in blunt trauma which is usually treated with analgesia, oxygen, and other conservative measures. In more severe cases mechanical ventilation and surgical stabilization of rib fractures (SSRF) may be warranted. Penetrating injury to the heart or great vessels due to rib fractures however, is much less common. Here we present a 33 year old male that was admitted to the Emergency department (ED) after a horse riding accident, demonstrating severe shock. Emergency computerized tomography scan showed multiple bilateral displaced rib fractures, Left hemothorax and possibly a penetrating injury to the left side of the heart by one of the ribs. Notably, no significant pericardial effusion was demonstrated. In addition, a grade V splenic injury was diagnosed. A Joined thoracic and abdominal emergent surgical treatment was successfully carried out and the patient survived and fully recovered.Romosozumab is a humanized monoclonal anti-sclerostin antibody (Scl-Ab) that binds and inhibits sclerostin, thereby increasing bone formation and decreasing bone resorption. In 2019, the Japanese Ministry of Health, Labor and Welfare, and the FDA approved romosozumab for treating osteoporosis in men and in postmenopausal women at high risk of fracture. In the past decade, pharmacological systemic treatments using molecules in use for the treatment of the osteoporosis have been reported. Herein we reported the case of a 67-year-old woman with nonunion of humerus shaft fracture, in whom bone union could not be achieved after 11 months of conservative treatment; however, successful bone healing was achieved after once-a-month administration of romosozumab for 6 months. To our knowledge, this is the first case reporting the successful use of romosozumab for treating established nonunion. Romosozumab can aid in promoting bone healing of nonunion in patients not willing to undergo surgical intervention.We present a rare case of humeral fracture dislocation with intrathoracic humeral head fragment. A 74-year old female was transferred to a major trauma facility after falling on her arm while gardening. An intrathoracic humeral head fragment was diagnosed after initial imaging. Selleck Lapatinib In correspondence with the department of thoracic surgery, the decision was made to remove the intrathoracic fragment thoracoscopically and succeed with a reverse total shoulder arthroplasty.Managing large bone defects in the setting of acute open fractures remains a challenging problem. We present a retrospective case series of acute lower limb open fractures with bone loss in the diaphysis, metaphysis and epiphysis addressed using the Masquelet technique. All cases present had at least 1 year follow-up with evidence of bony union and good functional outcome. Masquelet technique is both versatile and effective in managing acute open fracture with bone loss across bone regions.The Morel-Lavallée lesion (MLL) is an internal degloving injury typically associated with high-energy trauma and is suspected to be underdiagnosed in a majority of cases. Here, we illustrate the typical clinical and radiological characteristics of an extensive peripelvic MLL in a 50-year-old patient presenting to our trauma outpatient clinic with peripelvic pain, bruising and swelling six weeks after severe spine trauma caused by a high-energy car accident. Using this case study as an example, current therapeutic approaches are discussed. Therapeutic decisions should be based on clinical symptoms, lesion size, severity, age and co-morbidities. Extensive, symptomatic and chronic lesions should be addressed with early débridement, irrigation and drainage in order to prevent complications like infection or soft tissue necrosis.