Early Care of Polytraumatized Patients: A Framework for Orthopaedic Surgeons.

The role of orthopaedic surgeons during trauma activations is vague and often underused. Advanced trauma life support (ATLS) is a training program and framework for performing initial life- and limb-threatening interventions. ATLS was created by Dr.

Moving Past the Status Quo: Redefining the Feedback Landscape for Junior Clinician-Educator Career Development.

This perspective piece addresses the challenges junior clinician-educators face as they navigate career development within academic medical centers. In addition to understanding local promotion and tenure processes and seeking mentorship, we argue that faculty feedback is an often neglected, but essential, component in clinician-educator development. We repurpose and use the MISCA model-Message, Implementation, Student, Context, and Agents-as a framework to better understand and improve feedback for faculty.

Time between pancreatic cancer diagnosis and treatment initiation and survival in the U.S. Military Health System.

Background: Pancreatic cancer has a high case fatality and treatment is known to improve survival. It is unknown whether the time between diagnosis and treatment initiation (time-to-treatment) is related to survival. Access to medical care may influence both treatment receipt and timing.

Relugolix reduces leiomyoma extracellular matrix production via the TGF β pathway.

Objective: To determine if the oral GnRH antagonist relugolix affects leiomyoma extracellular matrix production through the TGF β pathway DESIGN: Laboratory Study SUBJECTS: None.

Intervention: Exposure of human leiomyoma cells to TGF β and/or relugolix MAIN OUTCOME MEASURES: Production of TGF β, pSMAD2/3, SMAD2/3, COL1A1, FN1 and VCAN in treated and untreated leiomyoma cells RESULTS: TGF β3 production was decreased at 24 hours with relugolix at 10nM (0.80 + 0.

radiosensitivity and Mn antioxidant content: antigenic preservation and pathobiology.

The bacterium responsible for Lyme disease, , accumulates high levels of manganese without iron and possesses a polyploid genome, characteristics suggesting potential extreme resistance to radiation. Contrary to expectations, we report that wild-type B31 cells are radiosensitive, with a gamma-radiation survival limit for 10 wild-type cells of <1 kGy. Thus, we explored radiosensitivity through electron paramagnetic resonance (EPR) spectroscopy by quantitating the fraction of Mn present as antioxidant Mn metabolite complexes (H-Mn).

Advances in the Treatment of Congenital Infiltrating Lipomatosis of the Face: The Role of PIK3CA Mutations and Microvascular Reconstruction.

Congenital infiltrating lipomatosis of the face is a rare aggressive-benign disorder characterized by progressive hemifacial overgrowth and complex, often asymmetrical, facial differences. Recently linked with the PIK3CA-Related Overgrowth Spectrum, it arises from mosaic mutations in the PIK3CA gene. Treatment, largely supportive and tailored to individual clinical presentations, requires a multidisciplinary approach.

Diffuse Axonal and Vascular Pathology in the Gyrencephalic Brain after High-Energy Blunt Injury: Clinicopathological Correlations Involving the Brainstem.

Traumatic brain injury (TBI) after high-energy, behind helmet blunt trauma (BHBT) is an important but poorly understood clinical entity often associated with apnea and death in humans. In this study, we use a swine model of high-energy BHBT to characterize key neuropathologies and their association with acute respiratory decompensation. Animals with either stable or critical vital signs were euthanized within 4 h after injury for neuropathological assessment, with emphasis on axonal and vascular pathologies in the brainstem.

Risk for exertional heat illness among US army enlistees: climate indexes, intrinsic factors and their interactions.

Objectives: To characterise intrinsic and extrinsic (climatic) risks for mild and severe exertional heat illness (EHI) among first-year army enlistees.

Methods: We examined 337 786 soldiers who enlisted between 2012 and 2019. Survival models were used to predict incident EHI from intrinsic factors (demographics, healthcare utilisation, chronic conditions, body mass index (BMI), Army Physical Fitness Test (APFT), upper/lower respiratory tract infections (URTI and LRTI), skin and soft-tissue infections (SSTI), extrinsic factors (geographical region, daily mean Universal Thermal Climate Index (UTCI), wet bulb globe temperature (WBGT)) and interactions.

Heterozygous UBR5 variants result in a neurodevelopmental syndrome with developmental delay, autism, and intellectual disability.

E3 ubiquitin ligases have been linked to developmental diseases including autism, Angelman syndrome (UBE3A), and Johanson-Blizzard syndrome (JBS) (UBR1). Here, we report variants in the E3 ligase UBR5 in 29 individuals presenting with a neurodevelopmental syndrome that includes developmental delay, autism, intellectual disability, epilepsy, movement disorders, and/or genital anomalies. Their phenotype is distinct from JBS due to the absence of exocrine pancreatic insufficiency and the presence of autism, epilepsy, and, in some probands, a movement disorder.

I'm Getting a Migraine: A Comparative Evaluation of Patient and Clinician Interpretations of Migraine Symptoms.

Patients and providers vary in how they describe common otolaryngology-related complaints. These differences can lead to miscommunication and frustration that may affect patient outcomes and satisfaction. The aim of this cross-sectional survey-based study was to explore the differences in migraine symptom selection by otolaryngology patients and clinicians.

Menopausal hormone therapy use among active duty service women.

Objective: Menopausal hormone therapy (HT) has been shown to be effective in alleviating symptoms of menopause. While previous literature has described the frequency of HT use for the relief of menopausal symptoms in both the general and veteran female populations, there is currently no literature describing this frequency within the female active duty population. This study aims to address this gap in knowledge by conducting a retrospective cross-sectional study of HT receipt in active duty service women (ADSW) ages 45 to 64 during fiscal years (FYs) 2018 to 2022.

A review of long-term outcomes of repetitive concussive and subconcussive blast exposures in the military and limitations of the literature.

The purpose of this review is to summarize the long-term cognitive, psychological, fluid biomarker, and neuroimaging outcomes following repetitive concussive and subconcussive blast exposures sustained through a military career. A review of the literature was conducted, with 450 manuscripts originally identified and 44 manuscripts ultimately included in the review. The most robust studies investigating how repetitive concussive and subconcussive exposures related to cognitive performance suggest there is no meaningful impact.

MRSA Cellulitis with Orbital and Retinal Abscesses Resulting in Lemierre Syndrome Following Eyebrow Piercing.

We describe a case of orbital cellulitis with abscess formation following eyebrow piercing complicated by internal jugular vein thrombosis and subretinal abscesses requiring enucleation with orbital abscess drainage. The popularity of body piercing is increasing and physicians should be familiar with the possibility and management of vision-threatening complications of facial piercing. Following left eyebrow piercing, a 20-year-old female experienced increasing periorbital swelling, erythema, chemosis, orbital pain, decreased vision, and concomitant fever, chills, and rhinorrhea.

Food-Away-From-Home Options in Local Military Nutrition Environments.

Introduction: Americans have increased their intake of food away from home, which is lower in quality and higher in calories than food prepared at home. The increase of operations that serve food also impacts the military nutrition environment-including all foods, beverages, and dietary supplements available to the military community-and its role in nutritional fitness.

Methods: As part of a pilot study, 5 military installations used the online Military Nutrition Environment Assessment Tool to evaluate their local food landscape.

Effectiveness of the primary Bacillus Calmette-Guérin vaccine against the risk of Mycobacterium tuberculosis infection and tuberculosis disease: a meta-analysis of individual participant data.

Background: Tuberculosis vaccine trials using disease as the primary endpoint are large, time consuming, and expensive. An earlier immunological measure of the protection against disease would accelerate tuberculosis vaccine development. We aimed to assess whether the effectiveness of the Bacillus Calmette-Guérin (BCG) vaccine for prevention of Mycobacterium tuberculosis infection was consistent with that for prevention of tuberculosis disease.

Effects of Stigmatizing Language on Trainees' Clinical Decision-Making in Substance Use Disorders: A Randomized Controlled Trial.

Objectives: Substance use disorder (SUD) continues to be one of the most stigmatized and under-treated conditions in the United States. Stigmatizing language used by healthcare workers can transmit bias to others within healthcare, including medical trainees. This study investigates how stigmatizing language and undergraduate medical education (UME) curricula may influence trainees' clinical decision-making for patients with SUD.

NELL1 variant protein (NV1) modulates hyper-inflammation, Th-1 mediated immune response, and the HIF-1α hypoxia pathway to promote healing in viral-induced lung injury.

Research underscores the urgent need for technological innovations to treat lung tissue damage from viral infections and the lasting impact of COVID-19. Our study demonstrates the effectiveness of recombinant human NV1 protein in promoting a pro-healing extracellular matrix that regulates homeostasis in response to excessive tissue reactions caused by infection and injury. NV1 achieves this by calibrating multiple biological mechanisms, including reducing hyperinflammatory cytokine levels (e.

Recurrent Lumbar Disk Herniation and Revision Surgery Rates After Single-Level Lumbar Microdiscectomy in the Military Population.

Background: Lumbar microdiscectomy remains the most commonly performed surgical procedure for symptomatic lumbar disk herniation (LDH). Despite advances in surgical techniques, recurrent LDH (rLDH) ranges from 5% to 24%, representing the most common cause of surgical failure and revision surgery. Optimal treatment of reherniation remains controversial.

Rhabdoid Tumor of the Kidney and Soft Tissues: Results from National Wilms Tumor Study-5 and Children's Oncology Group Study AREN0321.

Purpose: National Wilms Tumor Study-5 (NWTS-5) and AREN0321 evaluated the outcomes of children with rhabdoid tumor of the kidney (RTK) and malignant rhabdoid tumor of soft tissues (MRT).

Patients And Methods: Eligible patients with RTK were enrolled prospectively on NWTS-5 (1995-2002) and treated with carboplatin and etoposide alternating with cyclophosphamide (Regimen RTK). Patients with RTK or MRT were enrolled on AREN0321 (2005-2012) and received vincristine, doxorubicin, and cyclophosphamide alternating with carboplatin, cyclophosphamide, and etoposide (Regimens UH-1 or dose-reduced Revised UH-1).

Establishing an immune correlate of protection for Nipah virus in nonhuman primates.

The limited but recurrent outbreaks of the zoonotic Nipah virus (NiV) infection in humans, its high fatality rate, and the potential virus transmission from human to human make NiV a concerning threat with pandemic potential. There are no licensed vaccines to prevent infection and disease. A recombinant Hendra virus soluble G glycoprotein vaccine (HeV-sG-V) candidate was recently tested in a Phase I clinical trial.