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Summary: Self-antigen-specific T cells are prevalent in the mature adaptive immune system but are regulated through multiple mechanisms of tolerance. However, inflammatory conditions such as tissue injury may allow these T cells to break tolerance and trigger autoimmunity. To understand how the T cell repertoire responds to the presentation of self-antigen under highly stimulatory conditions, we use peptide:major histocompatibility complex (MHC) class II tetramers to track the behavior of endogenous CD4+ T cells with specificity to a lung-expressed self-antigen in mouse models of immune-mediated lung injury. Acute injury results in the exclusive expansion of CD4+ regulatory T cells (Tregs) that is dependent on self-antigen recognition and interleukin-2 (IL-2). Conversely, conventional CD4+ T cells of the same self-antigen specificity remain unresponsive even following Treg ablation. Thus, the self-antigen-specific CD4+ T cell repertoire is poised to serve a regulatory function during acute tissue damage to limit further damage and the possibility of autoimmunity.

This study's purpose is to develop a low-cost implementation of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in a rural level-2 trauma center. Literature and training to this point have involved urban level-1 trauma centers. This study examines the effectiveness of an in-house training program on trauma patient outcomes by comparing data from a matched historical control group of pre-REBOA patients (n = 32) to the REBOA intervention group (n = 17). The REBOA group had a similar ED to OR LOS (1.45 vs 1.79 hrs, P = .346) and similar ED LOS (1.36 vs 2.21 hrs, P = .01) as the historical control group. Although the REBOA group had a higher transfusion volume (6235.06 vs 2268.75 milliliters, P = .005), survival bias could be a factor. Resuscitative Endovascular Balloon Occlusion of the Aorta is considered a safe and affordable option for level-2 trauma centers without increasing complications or delaying time to the operating room., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Creel serves as the medical director for Airlife Georgia, an air medical service providing prehospital care. Neither he nor Mrs Mantooth have any other conflicts of interest or financial considerations to disclose.

Background: In Georgia, the paramedic's scope of practice prohibited the initiation of blood products. Due to the rural landscape in Georgia, one region's Regional Trauma Advisory Committee (RTAC) advocated expanding the scope of practice for Georgia's paramedics to allow them to initiate blood products in the prehospital environment. This study evaluated the safety and feasibility of allowing paramedics to initiate blood products for hemorrhaging patients utilizing a regionally established prehospital blood pilot program., Materials and Methods: Approval was obtained from the state medical directors and the Office of EMS and Trauma. The project team addressed product selection, equipment, prehospital service selection, education, policies and procedures, monitoring, and performance improvement. Four EMS services were identified to participate. Liquid plasma was selected due to cost and availability. Equipment was secured for blood storage and temperature monitoring to ensure the hospital's blood bank could maintain standards for exchange. A transfusion guideline was created, an administrative policy was developed, and an education plan was developed. A process with the trauma center's blood bank was also instituted to minimize waste and reduce costs., Results and Discussion: The pilot project began in spring of 2020, and as of January 2023, there have been 100 field initiations and no adverse effects, demonstrating the safety of paramedics to initiate blood products in the field. A post-licensure skill for paramedics is now available in Georgia for the initiation of blood products. The repeatability of a similar project depends on the resources available, the stakeholder commitment, and the partnerships across disciplines., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries.

We describe a patient who developed rhabdomyolysis 6 weeks after starting combination therapy with hydroxychloroquine and quinacrine for the treatment of chronic cutaneous lupus erythematosus (CCLE). Myopathy due to 4-aminoquinolone antimalarials has been well documented. It is plausible that quinacrine may induce muscle injury in a manner similar to other antimalarials but, to our knowledge, rhabdomyolysis associated with antimalarial therapy has not been reported.

Because the sex of mammals is chromosomally determined, populations generally produce a similar proportion of males and females. However, it has been recognized for more than century that individuals might increase their fitness by over-producing offspring of one sex, under certain conditions. Small biases in the secondary sex ratio are seen in many vertebrates. Here, we report that the sex ratio of primiparous African wild dogs (Lycaon pictus) is strongly biased in favor of sons (63%), while multiparous females produce an excess of daughters (64%). The direction of these biases is predicted by individual females' need for subordinate helpers. For humans, elevated estrogens have been hypothesized to bias the secondary sex ratio toward males. Consistent with this hypothesis, primiparous female wild dogs had basal estrogen levels double those of multiparous females.

African wild dogs (Lycaon pictus) are endangered, with only 3,000-5,000 remaining in the wild. It is believed that wild dogs are unusually vulnerable to viral diseases, particularly rabies and canine distemper (CDV). However, canine distemper has been confirmed by laboratory diagnosis in only one free-living wild dog. The 43,000 km2 Selous Game Reserve (SGR; Tanzania) holds approximately 900 adult wild dogs. In a study area of 2,600 km2, the population maintained high density (> or = 1 dog/20.5 km2) from 1991 to 1996. The population was stable, varying 18% below and 9% above the mean density over the 6-yr period. Serum samples (n = 22) collected over 3 yr showed that most individuals were exposed to CDV (59%:95% confidence interval = 43-76% seropositive) and canine parvovirus (68%:95% CI = 54-81% seropositive), although none were seropositive for rabies (0%:95% CI = 0-17%). CDV titers were positively related to age, with no seropositive dogs younger than 1.9 yr. At least five of 13 dogs positive for CDV seroconverted during the study. Dogs with high CDV titers did not survive better in the years after sampling (mean survival +/- SE for those that died = 638 +/- 92 days,). Variation in mean litter size was inversely related to CPV exposure in the SGR and elsewhere. Annual mortality rates were low in comparison to other populations for all age classes (pups: 31 +/- 8%, n = 127, yearlings: 22 +/- 10%, n = 93, adults: 20 +/- 6%, n = 235). Annual mortality rates fluctuated little between 1992 and 1996. These data show that wild dog populations, like those of other canids, can remain stable and demographically healthy despite exposure to CDV and CPV.

Study of the O.H. 7 hand was based primarily on morphological comparisons with a large series of hand skeletons of extant hominoid primates. Most of the hand elements are fragmentary or have missing epiphyses and only comparisons based on qualitative morphological observations are possible. The distal phalanges are complete, however, and were analyzed metrically utilizing univariate and multivariate statistical techniques. To compensate for size differences among the Hominoidea a number of size adjustments were employed. None of the adjustments were totally satisfactory from theoretical and practical standpoints and none completely eliminated the influence of size. There is no entirely satisfactory procedure to eliminate size and it is advisable to use several techniques that are not closely related, to compare the results and interpret them with caution. In certain features the wrist and fingers resemble those of African apes; in others they are more like modern human hands; in still others they are unique. The scaphoid and the proximal articular surface of the trapezium retain ape-like features, as do the proximal and middle phalanges. The pollical carpometacarpal joint and the distal phalanges are closer in morphology to those of modern humans. The scaphoid, proximal phalanges and middle phalanges of rays II-V indicate a hand capable of a strong power grip. A number of features of the thumb and the distal phalanges suggest that the O.H. 7 individual was capable of more precise manipulation that extant apes. FLK NN-A, a first distal phalanx, does not closely resemble the first distal phalanx of any of the living Hominoidea. Multivariate distance analysis indicates, however, that it is closest in overall morphology to the pollical distal phalanx of modern humans. In some features not included in the metric analysis, FLK NN-A also resembles the hallucial distal phalanx of modern humans.