Aortoduodenal Fistula With IgG4-Related Periaortitis: A Case Report.

A 77-year-old woman with a history of endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA) presented with melena. She had been recently diagnosed with IgG4-related periaortitis and started on prednisone. Physical examination revealed pallor conjunctiva and melena on the rectal examination, with laboratory results indicating anemia (hemoglobin: 7.

Postoperative Opioid Reduction Using a Multimodal Pain Protocol for Outpatient Orthopaedic Sports Medicine Surgery.

Background: Orthopaedic surgery regularly employs opioids for postoperative pain management. Multimodal pain protocols have been shown to reduce opioid prescriptions in orthopaedic surgery.

Purpose: To analyze the impact of a division-level multimodal pain protocol for orthopaedic sports medicine surgery on opioid prescription reduction and pain level postoperatively.

A Novel, Low-Fidelity, Low-Cost Residency "Simulation Festival" Competition.

Introduction: Simulation has rapidly expanded in obstetrics and gynecology (OB/GYN) for teaching surgical skills, reinforcing medical knowledge and assessing surgical proficiency. Low-fidelity simulations are typically lower cost to produce and have been proven to be beneficial for surgical training. The aim of this study is to describe an innovative simulation competition among residency programs to develop, present, and share low-cost, low-fidelity surgical simulation.

Barriers to Mohs Micrographic Surgery in Japanese Patients With Basal Cell Carcinoma.

Mohs micrographic surgery (MMS) is a well-recognized treatment for nonmelanoma skin cancer worldwide, but Japan has lagged behind many other countries in adopting MMS. We present a series of 5 cases of MMS utilized in Japanese patients. All cases had a favorable outcome, each benefiting from MMS with a smaller final defect or a higher likelihood of cure than standard excision.

Neocortical cholinergic pathology after neonatal brain injury is increased by Alzheimer's disease-related genes in mice.

Hypoxic-ischemic encephalopathy (HIE) in neonates causes mortality and neurologic morbidity, including poor cognition with a complex neuropathology. Injury to the cholinergic basal forebrain and its rich innervation of cerebral cortex may also drive cognitive pathology. It is uncertain whether genes associated with adult cognition-related neurodegeneration worsen outcomes after neonatal HIE.

Regional anesthesia in resource-limited and disaster environments: a daring discourse.

Regional anesthesia (RA) is commonly used in perioperative settings of developed and well-resourced environments. RA has significant potential benefits when used in resource-limited environments, including disaster, mass casualty, and wartime environments. RA offers benefits over general anesthesia and opioid-based analgesia, including decreased risk of complications, decreased reliance on mechanical ventilation, improved cost efficiency, and others.

Whole unstimulated salivary flow rate decreases during acute stressful condition.

Objective: To examine the influence of acute stress on salivary flow using a validated stressor paradigm.

Study Design: This uniform crossover study consisted of 40 healthy adults who underwent the Trier Social Stress Test, consisting of a 5-minute mental arithmetic task (MAT), and a nonstressful task (NST), consisting of a 5-minute free speech task. The order of the tasks was counterbalanced and unstimulated whole saliva (UWS) was measured in 2 groups of 20 participants during each 5-minute task condition, with a 10-minute washout period between tasks.

Whole blood transfusion among allied partnerships: unified and interoperable blood banking for optimised care.

Whole blood transfusion is being increasingly used for trauma resuscitation, particularly in military settings. Low-titre group O whole blood simplifies the logistical challenges and maximises the benefits of blood transfusion when compared with component therapy in austere battlefield conditions. Screening protocols and blood testing requirements for prescreened donors in walking blood banks (WBBs), which are used for emergency transfusions, are established by both the USA and most partner nations, though they are not necessarily uniform across these combined forces.

Oral opioid prescribing to active duty US military personnel: a cross-sectional population.

Introduction: While civilian opioid prescriptions have seen a dramatic decline in recent years, there are few studies investigating trends in opioid prescription in the active duty military population. We evaluated oral opioid prescribing patterns to active duty military personnel in the Military Health System (MHS) from 2017 to 2020 to determine the incidence of opioid prescriptions as well as demographic and military-specific risk factors for receiving an oral opioid prescription.

Methods: The MHS Data Repository was queried from 2017 to 2020 to identify all outpatient oral opioid prescriptions to active duty military personnel in August of each year as well as demographic information on the study population.

Early development history of Botox (onabotulinumtoxinA).

The development of Botox (onabotulinumtoxinA) began in the 1970s as Dr. Scott was attempting to identify an injectable substance that would weaken the extraocular eye muscles in patients with strabismus as an alternative to muscle surgery. This search led to botulinum toxin type A, which was tested and developed over the next 15 years.

Pyogenic flexor tenosynovitis due to in an infant.

Pyogenic flexor tenosynovitis is relatively common but is seldom reported in young children. is increasingly recognised as a causative agent. We report on an infant who presented with a palmar deep space infection and pyogenic flexor tenosynovitis caused by is a fastidious, often culture-negative, organism which has been increasingly recognised as a cause of paediatric orthopaedic infections, including flexor tenosynovitis.

Medical operations in the 21st century: application of TAK among wartime medical assets.

Advances in technology have improved the ability for real-time communication and enhanced awareness of medically related information on the battlefield. A government off-the-shelf platform, Team Awareness Kit (TAK), may enhance the ability for battlefield healthcare delivery, evacuation, telecommunication, and medical command and control. Integration of TAK into existing medical infrastructure provides a global view of resources, patient movement and direct communication, significantly reducing the 'fog of war' as it relates to battlefield injury and evacuation.

Power of mentorship for civilian and military acute care surgeons: identifying and leveraging opportunities for longitudinal professional development.

Across disciplines, mentorship has been recognized as a key to success. Acute care surgeons, focused on the care of trauma surgery, emergency general surgery and surgical critical care, practice in a wide variety of settings and have unique mentorship needs across all phases of their career. Recognizing the need for robust mentorship and professional development, the American Association for the Surgery of Trauma (AAST) convened an expert panel entitled 'The Power of Mentorship' at the 81st annual meeting in September 2022 (Chicago, Illinois).

Myasthenia Gravis Presenting after Administration of the mRNA-1273 Vaccine.

Unlabelled: The mRNA-1273 SARS-CoV-2 vaccine received emergency use authorization in December 2021. We present a case of myasthenia gravis (MG) which became clinically apparent following vaccination against SARS-CoV-2. A 30-year-old man developed acute onset diplopia, 2 days after receiving his first mRNA-1273 vaccination against SARS-CoV-2.

Imaging of eggshells and eggs in the gastrointestinal tract: pictorial essay.

Ingestion of eggshell in its natural form or as ground and powdered product has become a popular means of dietary calcium supplementation in adults. These substances appear as conspicuous radiopaque material within the gastrointestinal tract on radiographs or computed tomography of the abdomen. The ingested eggshell fragments are usually visible as curvilinear structures on profile view, whereas the ground or powdered eggshells appear as granular densities.

Use of a head-mounted patient display in a task driven anaesthesia simulator: a randomised trial.

Introduction: Head-mounted displays (HMDs) are becoming increasingly investigated in the realm of healthcare. These devices are worn on the user's head and display information directly to the eye. This allows for near-constant delivery of information, regardless of user position.

Evaluating the role of negative affect and negative interpretation biases in emotional eating behavior.

Objective: The study of emotional eating, or (over)eating in response to emotions, may inform transdiagnostic interventions for eating pathology. Prior work has focused on the role of negative affect in promoting emotional eating. The present study sought to extend this work through examining the role of cognitive biases.

Effectiveness of a COVID-19 Preventive Sequestration Strategy: Deployment of the Aircraft Carrier USS Ronald Reagan (CVN-76).

Objectives: Develop and evaluate a pre-deployment sequestration (PDS) protocol to prevent SARS-CoV-2 cases on board the USS RONALD REAGAN (CVN-76).

Methods: The USS RONALD REAGAN includes a crew of approximately 3,000 Sailors and an embarked Air Wing of 2,000 personnel. The PDS was conducted in three waves of 14-day strict quarantines during the months of April and May 2020.

A randomized controlled trial of sleep study surveillance with targeted autoregulated positive airway pressure therapy for obstructive sleep apnea in pregnancy.

Background: Obstructive sleep apnea is associated with adverse pregnancy outcomes. The impact therapy for obstructive sleep apnea has on these pregnancy outcomes remains under investigated.

Objective: This study aimed to determine the effects of targeted autoregulated positive airway pressure in women at risk of obstructive sleep apnea on adverse pregnancy outcomes, cost, and natural history of obstructive sleep apnea.

Magnetic resonance-guided laser interstitial thermal therapy for pediatric periventricular nodular heterotopia-related epilepsy.

Objective: Periventricular nodular heterotopia (PVNH) is a result of disrupted neuronal migration from the ventricular system and can be a rare cause of refractory focal epilepsy. The goal of this case series was to describe the treatment of pediatric PVNH-related epilepsy with MR-guided laser interstitial thermal ablation.

Methods: Patients treated at a single institution with MR-guided laser interstitial thermal therapy (MRgLITT) for PVNH-related epilepsy were identified.

Regionalization of EMS Medical Direction for Naval Medical Forces Pacific.

Introduction: Medical direction has been the cornerstone to safe and effective prehospital and enroute care since the establishment of emergency medical services (EMS). Medical oversight by a physician has been shown to improve clinical outcomes in both settings. When the Navy Regional Office of the EMS Medical Director was established in 2016, it brought additional resources, including the addition of a paramedic and nurse EMS analyst and recruitment of additional local medical directors (LMDs).