St. George''s University

Wastewater-based epidemiology (WBE) allows for early surveillance of viral pathogens, including SARS-CoV-2. Simplified low-cost approaches are needed to deploy WBE surveillance in resource-limited small-island settings, where high sensitivity must be maintained. In this study, we optimized key upstream steps in an electronegative membrane virus adsorption-elution (VIRADEL) workflow, including sample acidification, composite sampling duration, and RT-qPCR inhibition mitigation. Wastewater influent was sampled at a pump station in Grenada using 12 h and 24 h time-weighted composite samples, concentrated using electronegative membrane VIRADEL with and without sample acidification (pH 3.5), and used Phi 6 (enveloped virus) and MS2 (non-enveloped virus) bacteriophages as process controls and PMMoV as a fecal-derived normalization target. Targets for SARS-CoV-2 N1 and a non-enveloped virus surrogate were measured by RT-qPCR. Quantitative wastewater data were compared to reported clinical cases in the community. Sample acidification significantly increased recovery of the enveloped process control, Phi 6 (p < 0.01) indicating improved efficiency in capturing enveloped viral targets during filtration. Twelve-hour composite samples had a false-negative percentage of 88%, while 24 h samples had only 6% false negatives and were able to mirror clinical case trends. Wastewater viral signals were detected 3-5 days prior to an increase in clinical cases. Hydraulic travel time within the contributing sewer network was not directly measured; therefore, the reported 3-5 day lead time reflects the combined effect of shedding dynamics, sampling integration, and sewer transport. This optimized workflow was deployed for nine months showing sustained analytical performance and operational feasibility.

To evaluate the technical and clinical efficacy of the low-profile braided occluder (LOBO) device for proximal splenic artery embolization (SAE) and compare its performance with conventional coil embolization. This retrospective multi-institutional study included 44 consecutive patients who underwent proximal SAE between June 2023 and October 2025. Demographic data, etiology, embolic device type, fluoroscopy time, radiation dose, and outcomes were recorded. Technical success was defined as complete angiographic occlusion using the index device. Clinical success was defined as the absence of rebleeding or reintervention within 30 days. Of the 44 patients (mean age, 43.2 years; 39

Anatomical education and research are built on the generosity of individuals who donate their bodies to advance science. However, the terminology traditionally used to describe these individuals—“specimens,” “cadavers,” or “cadaveric specimens”—risks objectifying the donor and obscuring their humanity. This paper examines the historical roots of depersonalized language, its persistence in contemporary research, and the ethical implications of its continuing use. Drawing on comparisons with the organ donation and transplantation literature and on calls within anatomy for reforming terminology, we propose humanizing alternatives such as “body donor,” “donor body,” or “anatomical donor.” The discussion emphasizes how terminology influences pedagogy, professional culture, and public trust in body donation programs. By embracing more respectful language, anatomists, surgeons, physicians, and dentists can better honor the gift of body donation and highlight the humanity of those who continue to teach us even after death, for example, Hic locus est ubi mors gaudet succurrere vitae .

Objectives Colorectal cancer (CRC) is the third most common cancer in the UK, yet recognition of familial risk and referrals for genetic assessment remains low. This project aimed to (1) develop and implement a streamlined clinical pathway for standardised family history (FH)-based CRC risk assessment and surveillance in patients referred for FH indications and (2) evaluate the feasibility and cost/time efficiency of standardised FH assessment in patients with symptomatic endoscopy to identify individuals with previously unrecognised familial CRC risk. A novel endoscopy genetic counsellor's (EGC) role was introduced to integrate genetic expertise into routine endoscopy services. Design A service improvement project was implemented at St. George's Hospital Endoscopy unit. Two cohorts were analysed retrospectively: (A) patients undergoing colonoscopy under FH-based surveillance pathway (n=211) and (B) patients referred under a symptomatic pathway (n=2019). Patients completed a web-based FH questionnaire service (FHQS), reviewed by the EGC, alongside clinical findings. Surveillance recommendations followed current practice guidelines. Results In cohort A, 65.8% (139/211) completed FHQS. Surveillance intervals were adjusted for 80.57% (112/139; p<0.001): 75% (105/139) downgraded and 5% (7/139) upgraded. Surveillance optimisation prevented 347 unwarranted colonoscopies, saving an estimated 288,010 pound. In cohort B, 19.9% (402/2019) responded to FHQS: 39.5% (159/402) classified as 'clear population risk'. Among 49% (197/402) triggered for three-generation FH assessment, 10.1% (20/197) were identified as moderate risk and 2% (4/197) as high risk. Conclusion Embedding FHQS-EGC within endoscopy enabled standardised FH assessment, improved CRC risk stratification and optimised colonoscopy surveillance. The scalable model supports wider integration of FH-trained staff to improve efficiency and genetic awareness within endoscopy services.

Background: The anterior cruciate ligament (ACL) and medial collateral ligament (MCL) display strikingly different healing behaviors, despite their similar structural roles within the knee. The epiligament (EL)-a vascular and cellular envelope surrounding each ligament-has emerged as a critical determinant of repair capacity. The aim of this study was to perform a region-specific, comparative analysis of EL molecular profiles in the ACL and MCL to elucidate the mechanisms underlying their contrasting reparative outcomes. Methods: Human ACL and MCL specimens were obtained from 12 fresh knee joints. Immunohistochemical labeling for CD34, α-smooth muscle actin (α-SMA), and vascular endothelial growth factor (VEGF) was performed across proximal, mid-substance, and distal EL regions. Quantitative image analysis using IHC Profiler for ImageJ generated semiquantitative (negative, low-positive, positive) distributions, and inter-ligament comparisons were quantified using t-tests (p  <  0.05). Results: Distinct, region-specific EL signatures were identified. The ACL EL exhibited strong proximal α-SMA expression (0% neg/66.8% low+/33.2%+) and notable distal CD34 positivity (0% neg/83.3% low+/16.7%+), while VEGF expression was confined to the mid-substance (≈55% low+/26%+). In contrast, the MCL EL was largely negative for CD34 and VEGF across all regions, showing a homogeneous but functionally oriented α-SMA profile: proximally negative, sparse mid positivity, and high distal low-positive staining (93.4% low+). Differences in proximal and distal CD34 and α-SMA expression between the ACL and MCL were highly significant (p  <  0.0001-0.001), confirming a mechanistic divergence in EL organization. Conclusions: The ACL EL is regionally heterogeneous, vascularly biased, and enriched in contractile α-SMA+ cells, suggesting localized but poorly coordinated reparative potential. In contrast, the MCL EL is structurally uniform, with distributed α-SMA activity supporting stable wound contraction and tissue continuity, despite limited angiogenic signaling. These findings indicate that the ACL's failure to heal is not attributable to the absence of progenitor or angiogenic factors, but rather to its fragmented spatial organization and dominant contractile phenotype. Therapeutically, preserving and modulating the EL, particularly its CD34+ and α-SMA+ compartments, could be key to enhancing intrinsic ACL repair and improving outcomes in ligament reconstruction and regeneration.