U-turn lanes eliminate left turns at intersections and allow the manoeuvre to be made via median crossovers beyond the intersection. However, there are many situations where road infrastructures are characterized by the reduced width of the median. It is clear that, in such situations, we must adopt design criteria that take into account limitations imposed by the width of the cross-section of the road. This is the reason why it is necessary to adopt design solutions which expect a complete reorganization of the road section affected by the insertion of U-turns. In this paper, we intend to propose original guidelines for U-turn lane design, suitable to guarantee both the necessity to offer a high level of functionality of the road sections to be implemented by U-turns, and the principles of safety in order to reduce unsafe conditions during inversion manoeuvres as much as possible.

The absence of the musculocutaneous nerve represents a failure of the nerve to depart from the median nerve during early development. During a routine dissection of a 66-year-old white female cadaver, a bilateral absence of the musculocutaneous nerve was observed in the upper limbs. Muscles of the anterior flexor compartments of the arms including biceps brachii and brachialis were supplied by branches of the median nerve. The lateral cutaneous nerve of the forearm also branched from the median nerve. In a clinical case of a particularly high median nerve injury, a variation of an absent musculocutaneous nerve may not only result in typical median nerve palsy of the forearm and hand, but palsy in the arm that would manifest as deficiencies in both shoulder and elbow flexion as well as cutaneous sensory loss from the lateral forearm.

The musculocutaneous nerve (C5–C7) is a terminal branch of the lateral cord of the brachial plexus and provides motor innervation to the anterior compartment of arm muscles. Both the musculocutaneous and median nerve may show numerous anatomical variations. Keeping in mind possible aberrations in the course of the upper limb nerves may increase the safety and success rate of surgical procedures. The presented report is a detailed anatomical study of the fusion between the median and musculocutaneous nerve, supplemented by intraneural fascicular dissection. In the presented case, the musculocutaneous nerve was not found in its typical location in the axillary cavity and upper arm during the preliminary assessment. However, a careful intraneural fascicular dissection revealed that musculocutaneous nerve was fused with the median nerve and with its lateral root; Those nerves were surrounded by a common epineurium, however they were separable. The muscular branch to the biceps brachii muscle arose from the trunk ( fascicular bundle) dissected out from the median nerve and corresponding to the musculocutaneous nerve. Such variation may be of utmost clinical importance, especially during reconstructions of the brachial plexus or its branches.

Th e forearm is a body region of numerous anatomical variations. Due to its favorable anatomy fl exor digitorum superfi cialis muscle (FDS) is commonly used in tendon transfer surgeries. In this study a unique combination of abnormalities was found in a single forearm: the fl exor digitorum superfi cialis muscle penetrated by the median nerve, one of the fl exor digitorum superfi cialis tendons early division and absence of the palmaris longus muscle. Described variation potentially may lead to the clinical manifestation of the median nerve compression and should be also considered during FDS surgery.

Clinical records of dogs with spontaneous degenerative mitral valve disease (DMVD) with clinical signs related to congestive heart failure (CHF) recruited during routine clinical practice between 2001 and 2018 at the Cardiology Unit of the Veterinary Teaching Hospital (University of Milan) were included in this retrospective cohort study. Baseline echocardiographic data were evaluated. Median survival time (MST) was calculated. Data on therapeutic treatment, ISACHC (International Small Animal Cardiac Health Council) or ACVIM (American College of Veterinary Internal Medicine) classes were reviewed based on the inclusion period and type of endpoint (i.e. cardiac death or death for other causes). A univocal classification was needed, and the patients classified in ISACHC classes II, IIIa and IIIb, visited before 2009, were reallocated to ACVIM class C. The main goal of this data review was to retrospectively evaluate 259 clinical records of subjects belonging to ACVIM C class examined between 2001 to 2018 and 202 dogs examined between 2010 to 2018. In this way, in the second group, the bias of the reclassification was avoided. The MST (median survival time) of these subjects was 531 d (2001-2018) and 335.5 d (2010-2018), respectively. Univariate survival regression analysis for subjects included from 2010 to 2018 showed as significantly related to cardiac death (CD): left atrium to aorta ratio (LA/Ao) (HR 2.754, p=0.000), E wave (HR 2.961, p=0.000), E/A ratio (HR 1.372, p=0.000), end-diastolic (HR 1.007, p=0.000) (EDVI) and end-systolic (HR 1.012, p=0.026) (ESVI) volume indexes, allometric diastolic (HR 4.018, p=0.000) (LVIDdN) and systolic (HR 2.674, p=0.049) (LVIDsN) left ventricular internal diameters, age (HR 1.006, p=0.009) and pulmonary hypertension severity (HR=1.309, p=0.012) (PH). Multivariate analysis, adjusted for age, showed that the only variable that determined a statistically significant difference in MST was PH severity (HR 1.334, p=0.033). The type of therapeutic treatment within this class was not significant for the MST of the subjects.