Functional Changes to Achilles Tendon and Enthesis in a Mouse Model of an Adolescent Masculine Gender-Affirming Hormone Treatment.

Many transgender youth seek gender affirming care, such as puberty suppression, to prolong decision-making and to align their physical sex characteristics with their gender identity. During peripubertal growth, connective tissues such as tendon rapidly adapt to applied mechanical loads (e.g.

Mobility challenges and perceptions of autonomous vehicles for individuals with physical disabilities.

Background: Individuals with physical disabilities face many challenges, especially with mobility. Transportation plays a key role in an individual's health as it provides the access to critical services such as medical visits. Autonomous vehicles (AVs) can be one possible solution to increase transportation accessibility.

A Collaborative To Evaluate And Improve The Quality Of Surgical Care Delivered By The Military Health System.

In an effort to improve surgical quality and reduce clinical variability, the Military Health System (MHS) expanded its participation in the National Surgical Quality Improvement Program to all military hospitals beginning in 2015. This expansion and a partnership with the American College of Surgeons laid the foundation for a surgical quality collaborative in the MHS. We review the history of the program in the MHS and the activities that have contributed to developing the collaborative.

Response to infection control challenges in the deployed setting: Operations Iraqi and Enduring Freedom.

Background: Infections caused by multidrug-resistant organisms (MDROs), including Acinetobacter, have complicated the care of military personnel injured in Operations Iraqi and Enduring Freedom. Cumulative data suggest that nosocomial transmission of MDROs in deployed medical treatment facilities (MTFs) has contributed to these infections. A 2008 review of deployed MTFs identified multiple factors impeding the performance of infection prevention and control (IC) practices.

Menstrual cycle-related variations in postoperative analgesia with the preemptive use of N-methyl D-aspartate antagonist ketamine: a pilot study.

Several studies have supported that N-methyl-D-aspartate receptor antagonist can reduce the perception of postoperative pain. Hormonal fluctuations throughout the human menstrual cycle can influence pain pathways. In this pilot study, we evaluated postoperative pain in 22 female participants between the ages of 20 and 56 years undergoing laparoscopic abdominal procedures.

Now and then: combat casualty care policies for Operation Iraqi Freedom and Operation Enduring Freedom compared with those of Vietnam.

Between December 2004 and June 2007, 13 key Operation Iraqi Freedom/Operation Enduring Freedom combat casualty care policies were published to inform medical practice in the combat theater of operations. Published policies were authored by the 44th Medical Command (1), the Office of The Army Surgeon General (11), and the Office of the Assistant Secretary of Defense (Health Affairs) (1). These policies, published as an All Army Action message (and/or in memorandum format signed by The Army Surgeon General), were compared with published medical newsletters and medical bulletins issued during the Vietnam War era, beginning in 1966.

Physiological changes in venous hemodynamics associated with elective fasciotomy.

It has been postulated that lower extremity fasciotomy may disrupt the calf musculovenous pump and predisposes to development of chronic venous insufficiency (CVI). However, studies based on trauma patients who undergo emergent fasciotomy are confounded by the possibility of concomitant vascular and soft tissue injury and use historical controls. This is a prospective study that evaluates venous hemodynamics in young patients undergoing elective fasciotomy for chronic exertional compartment syndrome (CECS), eliminating the problems associated with retrospective study of trauma patients.

Could gut-liver function derangements cause chronic venous insufficiency?

Upregulation of adhesion molecules and neutrophil infiltration of venous valve cusps may be risk factors for chronic venous insufficiency. But studies that focus on the target organ (vein) fail to consider the influence of systemic inflammation on WBC behavior in the microcirculation. This study probes the gut-liver axis as a potential source of gut-derived oxidative stress and free radical production leading to white blood cell activation in chronic venous insufficiency.

Will transcatheter embolotherapy replace surgery in the treatment of gastrointestinal bleeding?(2)(2).

Superselective angiography and transcatheter embolization (SATE) have produced mixed results in the treatment of upper gastrointestinal bleeding (UGIB). The use of SATE to treat hemorrhage distal to the ligament of Treitz has been approached with trepidation because of limited collateral blood supply to the gastrointestinal tract beyond the duodenum. Ischemic bowel injury rates of 15% to 35% are reported when SATE is used to treat lower gastrointestinal bleeding (LGIB).

Seromuscular enteric pedicles and prosthetic aortic graft complications in a porcine abdominal trauma model. An experimental study.

Background/aims: Abdominal vascular trauma may require prosthetic grafting despite peritoneal contamination by concurrent visceral injury. This study tested the use of vascularized, seromuscular enteric pedicles (VSEP) against the development of vascular prosthetic complications, in a porcine abdominal trauma model.

Methods: Eight pigs underwent aortic transection and reconstruction with a Dacron interposition graft (DIG).

Use of a critical pathway to move laparoscopic cholecystectomy to the ambulatory surgery arena.

Critical pathways are being implemented in health care facilities across the nation as a cost-containment tool. When developed using best practice based on a literature review and the collaboration of a multidisciplinary team, critical pathways can be very successful in maintaining or increasing the quality of care while controlling the cost of the care provided. The Department of Defense Utilization Management Plan strongly encourages the use of pathways.

Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization.

Purpose: This case series describes the early radiographic and clinical results of attempted transcatheter ovarian vein (OV) embolization in 11 women with symptoms that were suggestive of the pelvic congestion syndrome (PCS).

Methods: Eleven women (mean age, 33.1 years) who were multiparous were referred for lower extremity or vulvar varicosities (n = 8) or for tubo-ovarian varicosities (n = 3).

Mycotic renal artery degeneration and systemic sepsis caused by infected renal artery stent.

A case of Staphylococcus aureus renal artery stent infection was studied. Fourteen days after the procedure, the patient had a fever, hypotension, and an elevated white blood cell (WBC) count. Blood cultures were positive for S.

Use of an intuitive telemanipulator system for remote trauma surgery: an experimental study.

Background: Death from battlefield trauma occurs rapidly. Potentially salvageable casualties generally exsanguinate from truncal hemorrhage before operative intervention is possible. An intuitive telemanipulator system that would allow distant surgeons to remotely treat injured patients could improve the outcome from severe injuries.

Anatomic and physiologic changes in lower extremity venous hemodynamics associated with pregnancy.

Purpose: The purpose of this study was to describe the physiologic effects of pregnancy on lower extremity venous hemodynamics.

Methods: Eight pregnant women, six with no known venous disease (NVD) and two with documented deep venous obstruction (DVO), were identified in the first trimester (TM) and studied monthly until delivery and once postpartum (pp) by air plethysmography and duplex scan.

Results: None of six women in the NVD group (12 extremities) had obstruction or elevated ambulatory venous pressures as estimated by air plethysmography.

The influence of wound geometry on the measurement of wound healing rates in clinical trials.

Purpose: The comparison of wound healing rates in clinical trials presents a challenging problem. Wound healing typically has been expressed as a change in area over time or a percent change in area over time. These methods are inaccurate, however, when applied to wounds of varying size and shape.

Vascular applications of telepresence surgery: initial feasibility studies in swine.

Purpose: Telepresence surgery is a novel technology that will allow procedures to be performed on a patient at locations that are physically remote from the operating surgeon. This new method provides the sensory illusion that the surgeon's hands are in direct contact with the patient. We studied the feasibility of the use of telepresence surgery to perform basic operations in vascular surgery, including tissue dissection, vessel manipulation, and suturing.

Complex task performance in Cyberspace. Surgical procedures in a telepresence environment.

To assess the capabilities of our fully functional, prototype telepresence surgery system, experienced surgeons performed complete operative procedures on live, anesthetized pigs. Cholecystectomy, the prototypical procedure for evaluating the integration of surgical skills, was successfully performed in six animals. There were no aborted attempts or complications.

Traumatic aneurysm of the superficial temporal artery: case report.

Traumatic aneurysms of the temporal artery are uncommon, with less than 200 cases reported in the literature. A case resulting from a head injury from playing a popular new survival game known as "paintball" is presented here. A general review of the literature on traumatic temporal artery aneurysms is provided, as well as information on this new form of recreation and safety recommendations for "paintball" players.

Can air plethysmography accurately identify upper extremity deep venous thrombosis?

Purpose: Air plethysmography (APG) is an established, noninvasive means of evaluating lower extremity venous outflow.

Methods: To determine whether APG could identify deep venous thrombosis (DVT) of the upper extremity, we measured the percentage of venous outflow in the first second (maximum venous outflow [MVO]) of four groups of arms: (1) normal volunteers (no previous central vein catheters), (2) the affected, (3) the unaffected arms of the patients with DVT (proven by venography or duplex scanning), and (4) hospital patients (no previous central vein catheters).

Results: The results of an analysis of variance were as follows: the mean MVO (%) of the affected arms of patients with DVT, 29.

Do infected inguinal lymph nodes increase the incidence of postoperative groin wound infection?

Purpose: Risk factors for postoperative wound infection in patients undergoing vascular surgery may include age, comorbid conditions, wound classification, use of prosthetic grafts, and repeat operations. Groin incisions, in particular, pose substantial risk during placement of prosthetic grafts.

Methods: To investigate the role of infected inguinal lymph nodes (LN) in groin wound infection (GWI), we excised an inguinal LN from 69 consecutive patients (89 groins) undergoing 36 infrainguinal reconstructions, 24 aortobifemoral bypasses, 12 extra-anatomic femoral bypasses, 11 vein stripping, and 6 femoral pseudoaneurysm repairs.