Course Of Operation Research Articles

THE PECULIARITIES IN THE FORMATION OF GUNSHOT WOUNDS CHANNELS CAUSED BY 7.62 MM EXPANSIVE «HPBT» AND «SP» TYPE BULLETS

The aim of the study – to study the peculiarities of wound channel formation, causedby 7.62 mm «HPBT» and «SP» bullets, by means of experimental methods of forensicballistics with the use of human biological tissue simulators.Materials and methods. Experimental investigations were carried out under conditionsof the ballistic route of the National Scientific Center «Hon. Prof. M. S. Bokarius ForensicScience Institute». To determine the velocities of the fired bullets, the optoelectronicmeasuring complexes IBX-731.4 were used. Ballistic plasticine «Beschussmasse,6287156» was used as a simulator of human body tissues. The experimental shooting wascarried out with a TS.M308 model .308 «Winchester» sniper rifle. For the experimentalshooting 7.62 × 51 mm (.308 «Winchester») cartridges were used, which were filled with«SP» and «HPBT» bullets.Results. In the course of experimental shooting, the peculiarities of the formation ofdamage channels caused by 7.62 mm «SP» and «HPBT» bullets were determined. Basedon the results of experimental studies, it has been found that the bullets of these types ofthe same caliber and practically the same mass are able to cause different amounts ofbodily injury, which is primarily due to the peculiarities of the design of the bullets. SPtype bullets with a bare core cause more severe bodily injuries, they are less subject tofragmentation and in most cases retain a relatively heavy bottom part. As a consequence,such bullets are able to cause longer wound channels than other types of expansivebullets. HPBT-type bullets can also cause sufficiently large amounts of bodily injury,but because of their design, they are more prone to fragmentation when hitting thehuman body. In the course of the research it has been established that there are severalperipheral (secondary) channels in the area of the main wound channel. They are formeddue to destruction of the bullet and movement of its separate fragments away from themain direction, which leads to complication of diagnostics and further treatment of suchgunshot wounds.Conclusions. The use of 7.62 × 51 mm (.308 «Winchester») expansive «SP» and «HPBT»type bullets in the course of combat operations for firing modern sniper systems resultsto severe bodily injuries. Wounds caused by such bullets are characterized by significantin volume zones of direct traumatic necrosis (contusion), which significantly extend deepinto the tissues and structures of the human body and form even larger in size zonesof conditional necrosis (contusion) and morpho- functional changes. The formationnature of both the main wound channel and the peripheral wound channels, caused byfragments of bullet structural elements, depends on the velocity, design features andposition (projection) of the bullet at the moment of impact. Changes in biological tissuesin the area of wounds caused by these types of expansive bullets have rather complexarchitectonics, which significantly complicates the issue of clear delimitation of gunshotwound zones and adequate surgical intervention. The used investigation methods of thestriking properties of expansive bullets are suitable for predicting the severity and volumeof the caused injuries, as well as for determining the individual characteristic complex ofgunshot wounds signs caused by such bullets.

Prompt-WNQA: A prompt-based complex question answering for wireless network over knowledge graph

With the rapid development of wireless networks, the scale of network devices is constantly expanding. Experts spend vast amounts of time consulting and dealing with various network problems of the same nature during the course of daily network operation and maintenance service, and there is no time to collect statistics and sort their information, which affects the overall operation and maintenance efficiency. This paper investigates complex Knowledge Graph Question Answering (KGQA) in the wireless network domain in order to improve operation and maintenance efficiency. Accordingly, we propose Wireless Network QA over the KG using Prompt learning (Prompt-WNQA), a novel method that deals with both constraint-based and multi-hop complex questions making use of prompt learning. Our method is also helpful in performing complex KGQA over incomplete KGs, which can complete missing relations between unconnected entities. Compared to state-of-the-art approaches, our Prompt-WNQA achieves significant improvement over extensive experiments on both the wireless network QA dataset and two public complex QA datasets.

Prediction of Early Recurrence Following CRS/HIPEC in Patients With Disseminated Appendiceal Cancer

IntroductionIn patients with disseminated appendiceal cancer (dAC) who underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), characterizing and predicting those who will develop early recurrence could provide a framework for personalizing follow-up. This study aims to: (1) characterize patients with dAC that are at risk for recurrence within 2 y following of CRS ± HIPEC (early recurrence; ER), (2) utilize automated machine learning (AutoML) to predict at-risk patients, and (3) identifying factors that are influential for prediction. MethodsA 12-institution cohort of patients with dAC treated with CRS ± HIPEC between 2000 and 2017 was used to train predictive models using H2O.ai's AutoML. Patients with early recurrence (ER) were compared to those who did not have recurrence or presented with recurrence after 2 y (control; C). However, 75% of the data was used for training and 25% for validation, and models were 5-fold cross-validated. ResultsA total of 949 patients were included, with 337 ER patients (35.5%). Patients with ER had higher markers of inflammation, worse disease burden with poor response, and received greater intraoperative fluids/blood products. The highest performing AutoML model was a Stacked Ensemble (area under the curve = 0.78, area under the curve precision recall = 0.66, positive predictive value = 85%, and negative predictive value = 63%). Prediction was influenced by blood markers, operative course, and factors associated with worse disease burden. ConclusionsIn this multi-institutional cohort of dAC patients that underwent CRS ± HIPEC, AutoML performed well in predicting patients with ER. Variables suggestive of poor tumor biology were the most influential for prediction. Our work provides a framework for identifying patients with ER that might benefit from shorter interval surveillance early after surgery.

Ultrasound-assisted preparation of uniform BiInSn phase change microparticles for enhanced thermal interface materials through in-situ low-temperature soldering

Micro/nano scale metallic phase change materials (mPCM) have attracted interested for constructing thermal interface materials (TIM), which can rapidly transfer heat away and store the latent heat and buffer the temperature on the course of the high-power operation. However, it is still a great challenge to prepare mPCM particles in micro/nano scale with uniform size and morphology. Here, we successfully prepared a series of BiInSn spherical particles with adjustable size in the range of 1.21–5.45 μm through an ultrasonic-assisted bath method. Especially, the BiInSn spherical particles with the uniform size of ∼5 μm are prepared under the condition of 450 W, 70 °C and 40 min. The prepared BiInSn particles maintain the characteristics of low melting point (∼61 °C) and high latent heat (∼29.95 J g−1) of bulk BiInSn, which are further compounded with Al particles to construct a TIM, and a high thermal conductivity (3.24 W m−1K−1) is reached by adding BiInSn spheres (5 μm, 5 wt%) as functional fillers. The SEM reveals BiInSn microparticles can melt and bridge the adjacent Al particles to build an efficient heat-conducting network. The mPCM particles will be increasingly used in other fields including 3D printing, sensing, smart materials and so on.

Reflecting on the Ganga Hospital Visit: Insights and Lessons Learned from the 2023 Operative Hand Course.

Reflecting on the Ganga Hospital Visit: Insights and Lessons Learned from the 2023 Operative Hand Course.

1219 A Rare Case of EBV Infection Presenting as Acute Appendicitis with Septic Shock - a Case Report and Review of the Literature

Abstract 18yo male presented to the emergency department (ED) with a 2-week history of progressive lower abdominal pain, weight loss of 8kg & diarrhoea. On examination he looked dehydrated, was tachycardic and had a large, tender, palpable mass in his lower abdomen up to the umbilicus. Blood investigations of note were white cell count (WCC) 29.7 and CRP 187. Computerized tomography (CT) reported an extremely large abscess occupying the lower abdomen and pelvis resulting in bilateral hydronephrosis and hydroureter. The appendix was not visualised. On the night of admission, the patient went into septic shock on the ward and was taken to theatre from emergency laparotomy. 4 litres of a large abscess were evacuated, the appendix was identified with an inflamed appearance and an appendicetomy performed. His post operative course was complicated by an ileus and slow resolving, inter-loop abscesses that required multiple courses of antibiotics and eventual return to theatre for further washout. During his early admission, EBV serology was recommended by the microbiology team on foot of a positive monospot test. Serology was also positive for EBV. Histopathological results of the appendix and lymph nodes showed EBV associated changes. Acute appendicitis can be considered a complication of EBV infection with the proposed mechanism being obstruction of the appendiceal lumen due to swollen lymphoid tissue, this most commonly occurs in the acute phase of EBV infection. In this case it has been shown that EBV and subsequent Infectious mononucleosis can cause acute appendicitis and may be its initial presentation.

Laparoscopic prophylactic total gastrectomy with limited lymphadenectomy for CDH1 gene carriers.

CDH1 gene mutations are the leading etiology of hereditary diffuse gastric cancer with cumulative lifetime risk ranging up to 83%. Prophylactic total gastrectomy (PTG) is, therefore, recommended for CDH1 carriers. A laparoscopic approach may reduce operative risk versus an open operation, thus leading more patients with CDH1 mutations to pursue PTG prior to cancer development. However, more experience and oncologic outcome data are needed for a laparoscopic approach and indicated lymphadenectomy. A retrospective descriptive cohort study of adult patients with CDH1 mutations who underwent laparoscopic PTG with D1 lymphadenectomy between 2012 and 2022 was conducted at a single institution. All patients had preoperative EGD screening, and those with visible tumor lesions on surveillance EGD were excluded and not considered prophylactic. Demographics, family history, pathology, and operative course were obtained. Outcomes included complications, readmission, and postoperative weight change. Among 23 patients, median age was 48years (IQR 37, 53) and 15 (65%) were female. Family history for gastric and/or lobular breast cancer was present in 22 (96%) patients. The median [IQR] time from positive genetic testing to PTG was 347days [140, 625]. Pathologic evaluation showed five (22%) patients with foci of gastric cancer on pre-operative EGD biopsies, 10 (44%) in resected stomach specimens. All lymph nodes were negative. To address early postoperative complications, EJ anastomotic technique changed from EEA to GIA over the course of the study and feeding jejunostomy was no longer placed during PTG with minimal change in postoperative weight loss. This is the largest series, spanning 10years at a single institution, dedicated solely to a laparoscopic approach for risk-reducing PTG. A laparoscopic approach with limited lymphadenectomy resulted in acceptable surgical and oncologic outcomes. Despite no visible cancer, over half of our patients had foci of early gastric cancer. Therefore, CDH1 carriers should consider laparoscopic PTG.

Online and Remote Training Experience in the Engine Room Simulator Training Courses using the IMO Model Course 2.07 Exercises

In the age of technology, changes are experienced in many areas such as globalization, information society, new basic technology, the spread of the Internet, and the realization of competition on a global scale. New methods used in education and training have been developed and kept up with technological developments. With the widespread use of the Internet, online and remote training has become more possible than ever. Technology was ready for online education and training for the past decades, yet the COVID-19 pandemic caused the traditional training to be disrupted and training institutions had to carry out studies for traditional training to be conducted online and remotely. This caused a paradigm change in the training methods. Online or remote education, even in training using the engine room simulator (ERS), has become more popular as an alternative to traditional classroom teachings, even though the pandemic is disappearing. Additionally, the progress in autonomous ships and recent regulatory studies indicates the importance of a better understanding of the engineering data in remote or autonomous ship operations. The authors have been offering Engine Room Simulator (ERS) training courses using online methods since the first semester of 2020, totaling six semesters of online training so far. This paper presents the online training process used in courses including the technological setup and method of teaching and assessment. Experiences and lessons learned by the lecturers in providing operational and management level ERS courses and feedback from students are examined and presented. The use of IMO Model Course 2017 Edition became helpful as it describes exercises for each training objective in accordance with IMO STCW 2010. An Engine Room Simulator (ERS) called Ship ERS or SERS™ was utilized as the remote training tool in the pilot implementation of these courses that were spread over two semesters. The advantages and disadvantages of online ERS training was presented and discussed. A particular and interesting observation has been that the students could have longer duration of exercise opportunities when using SERS™ in the remote training than in traditional ones.

Ukrainian soil pollution before and after the Russian invasion

ABSTRACT Russia’s invasion of Ukraine has already caused pervasive pollution. To appreciate the scale of the problem, identify its causes and consequences, and develop strategies and practical counter measures, we present a comprehensive picture of soil pollution with more detailed analysis in Kharkiv, Kherson and Zaporizhzhia regions. The intensity of contamination depends on location, industrial development and the course of military operations. In the east of the country, illegal dumping of chemical waste as well as active hostilities have caused significant soil contamination with heavy metals and oil products: Kharkiv region showed a 200% increase in cadmium contamination; Kherson and Zaporizhzhia regions showed a 139% and 156% increase in oil spills; all with serious consequences for public and environmental health.

Intraoperative Peritoneal Lavage in Peritonitis: Normal Saline vs Metronidazole

Introduction: Globally, acute generalized peritonitis ranks among the top surgical emergencies. Different studies have been conducted to show the amplitude of peritonitis worldwide eliciting a huge impact on overall patient morbidity and mortality. Largely peritonitis is caused by a gastrointestinal perforation or anastomotic leak. In peritonitis, anaerobes & gram-negative organisms are mostly responsible for sepsis and morbidity due to the overactive inflammatory cascade by endotoxins which is amenable to timely intervention. Aims & Objectives: The study's aim was to evaluate whether using normal saline or metronidazole solution during intraoperative peritoneal lavage (IOPL), results in a lower rate of postoperative wound infection. Place and Duration of Study: This study was undertaken at the South Surgical Ward, Mayo Hospital Lahore for 6 months from February 2nd, 2021, to August 1st, 2021. Material & Methods: Consecutive sampling strategy followed by a randomized controlled trial were used to induct and provide intervention to 90 patients aged 15-65 years with peritonitis caused by hollow viscus perforation. The patients were subdivided into 2 groups A& B(n=45 each).Two liters of normal saline were used for peritoneal lavage in group A, while two liters of normal saline were combined with 200 mL of metronidazole solution and administered to group B. intraoperatively.Baseline physiological parameters such as age, sex, BMI , intra operative surgical parameters as duration of operation and post-operative course were recorded till discharge. On 10th POD, patients returned to OPD for further monitoring. An infection was diagnosed if the patient had post-operative symptoms such as a high temperature, increased TLC, wound discharge, redness, or pain. Data was entered and analyzed using SPSS version 23. Results: A majority (54.44%) of the patients were young adults. Mean age of 37.33 ± 10.53 years of patients in the metronidazole group was comparable to mean age 40.04 ± 11.96 years in the saline group, difference was not significant (p=0.067). Male/female ratio in Metronidazole and Saline groups were 17/25 and 10/18, respectively. Patients who received intraperitoneal lavage with normal saline were more likely to develop wound infections (17/45) (37.78%), while only 3/45) (6.67% of those who received metronidazole solution did so (p 0.0001). Conclusion: Based on the results of this experiment, using metronidazole solution for intraoperative peritoneal lavage instead of normal saline reduces the occurrence of postoperative wound infection.

О некоторых аспектах финансирования крупномасштабных инвестиционных проектов в современных условиях

The overdue changes in the world geopolitical alignments, along with the change in the role of Russia in the world economy, are confirmed by the course of a special military operation. For the current stage of economic development, systemic solutions are needed to ensure the solution of the tasks set by the President of the Russian Federation in the shortest possible time. For the economic sphere, this concerns its restructuring as soon as possible for subsequent functioning in the conditions of mobilization of all available resources. The implementation of large-scale (priority) investment projects is the tool that makes the maximum contribution to the formation of the country’s GDP, provides the conditions for its preservation and development in the long term. Therefore, the study is aimed at identifying some aspects of financing large-scale investment projects in modern conditions.

Outcomes of preoperative fragmented QRS detection on operative and postoperative events in patients undergoing elective coronary artery bypass grafting

Objectives: This study aims to investigate the preoperative electrocardiographic data of patients who were candidates for elective coronary artery bypass grafting (CABG) in terms of fragmented QRS (fQRS) presence and to evaluate short-term outcomes of fQRS on operative and postoperative courses. Patients and methods: Between January 2019 and April 2022, a total of 178 patients (137 males, 41 females; mean age: 61.4±9.3 years; range, 39 to 85 years) who underwent elective CABG were retrospectively analyzed. Preoperative electrocardiographic examinations were performed to detect fQRS. The patients were divided into two groups according to presence of fQRS as the fQRS+ (n=35) and fQRS– (n=143) group. Demographic, clinical, laboratory, operative, and postoperative data of both groups were evaluated. Results: The mean duration of cardiopulmonary bypass (p=0.017) and number of CABG (p=0.026) in the fQRS group were found to be significantly higher, while the mean preoperative left ventricular ejection fraction values were lower in this group (p<0.001). There was a significant increase in the left ventricular ejection fraction values at the postoperative third month in the fQRS+ group (p<0.001). Mortality encountered in 5.7% in the fQRS+ group, while this rate was 2.7% in the fQRS– group (p=0.336). Conclusion: Preoperative detection of QRS fragmentations on admission electrocardiograms may have an additional value in predicting postoperative cardiac status and short-term prognosis in patients undergoing CABG.

Transthoracic resection of hyperplastic parathyroid gland via a uniportal video-assisted thoracic surgery technique

Uniportal video-assisted thoracic surgery has grown in popularity in recent years, becoming the treatment of choice for minimally invasive resections of mediastinal lesions. The many advantages of video-assisted thoracic surgery, including decreasing postoperative pain, morbidity and length of hospitalization, have increased its utilization for optimal patient care. In our case, this approach was used on a 55-year-old female patient who presented with a retrotracheal mass protruding through the thoracic inlet. The resection was performed through the chest via a uniportal video-assisted thoracic surgery technique with an unremarkable operative and postoperative course.

Point-of-Care Tissue Oxygenation Assessment with SnapshotNIR for Alloplastic and Autologous Breast Reconstruction.

Patients receiving immediate alloplastic reconstruction after mastectomy or autologous reconstruction were enrolled. Preoperative, intraoperative, and postoperative images were taken of the flaps. StO2 and hemoglobin were measured at the following locations: superior and inferior breast, free flap skin paddle (when applicable), and un-operated control skin. Linear mixed effects model for repeated measurements was used to model measurements to estimate the area effect difference across time, time effect difference across area, and pairwise comparisons between two areas at each time point. Thirty-two breasts underwent alloplastic reconstruction; 38 breasts underwent autologous reconstruction. No enrollees developed skin necrosis. StO2 was highest after mastectomy and closure in alloplastic reconstructions. StO2 was observed to decline at follow-up in autologous reconstructions. Mean preoperative StO2 was highest in breasts that had previously undergone mastectomy and alloplastic reconstruction. The SnapshotNIR device detected normal spatial and temporal differences in tissue oxygenation over the operative course of alloplastic and autologous breast reconstruction. A multi-institutional, prospective clinical trial is needed to determine the sensitivity and specificity of this device for detecting skin flap necrosis.

Study on Pressure Reconstruction Method of Explosion Shock Wave

Shock waves are one of the primary damage parameters of an ammunition explosion. Therefore, accurately obtaining the shock wave pressure distribution law after ammunition explosion is greatly significant for the ammunition damage power evaluation and the guidance of ammunition selection in the operations course. This study established the mapping function between the surface reflected and free-field shock wave pressures, considering the altitude effect on shock wave pressure. Finite element numerical simulation analysis of typical (trinitrotoluene) TNT explosive quality and static explosion shock wave pressure test were performed, and the model calculation accuracy was verified by using the obtained shock wave pressure data. The Validation results show that the model had 84% calculation accuracy and could well reflect the explosion shock wave pressure distribution law. Furthermore, the results provided a new calculation method and scientific data support for the accurate evaluation of the damage power of an ammunition explosion. Additionally, the results are significant for applications in engineering testing and the military.

Value Engineering Techniques and its Application in Construction Projects

Value Engineering (VE) is an efficient management technology that can significantly contribute to value rise and decrease in building projects. In addition to that EV is an accepted way of recognizing and removing excessive product construction, inspection, manufacture and design, operation, repairs. The technique comprises three main stages. The first step of the study on VE is designed to schedule and organize the study of significance. Value Engineering routinely employs well-known techniques that classify the functions of the innovative product or service and thus operate at the lowest average cost of performance. Value engineering relies on the lowest marginal feature efficiency. It enables waste, time, and unnecessary expenses to be eliminated or minimized that increases customer loyalty. The second step consists of several phases: knowledge phase, research purposes phase, innovative phase, assessment phase, and initial phase. The principal components of value engineering study are value analysis. Value analysis. The two steps and actions function sequentially. This series of approaches to the VE research goals will lead to a logical and organized process flow. The third step is postal analysis. It seeks to ensure that the acceptance criteria are applied to change the research of significance in the course of study operations. The second process consists of five phases: information phase, purpose analysis phase, creative phase, evaluation phase, and introduction phase. Value analysis is the main component of Value Engineering Research. Sequentially both stages and measures work. The rational and structured process flow is anticipated to help with this sequence of the approach to reach the VE research goals. The postal study is the third phase. It is intended to ensure the execution of the agreed guidelines to modify the important study during study operations. In the study, the values engineering principles are applied and value engineering practices in this project are defined by the study of the constructor project.

Evaluation of a new 3D-printed tooth model allowing preoperative ICDAS assessment and caries removal.

Teaching caries lesion management with operative care requires tooth models with highly realistic anatomical detail and caries lesions that can be assessed using ICDAS. This study aimed to develop and evaluate a new 3D-printed teeth model for ICDAS assessment and caries removal for pre-clinical hands-on education. Printable tooth with different layers for enamel, dentin and carious lesions was designed and tested by 31 dental students. They were asked to visually and radiologically assess the ICDAS severity of the simulated carious lesions, establish the therapeutic strategy according to CariesCare 4D, and perform a qualitative assessment of the models based on five-point Likert scale items. Concerning carious lesions, the texture was realistic, and the shade was adequate for 94% and 97% of the participants. Ninety per cent of the participants found the model adequate to perform an ICDAS visual assessment. Seventy-four per cent of the students found the hardness adequate. Concerning the difference in shade and the noticeable hardness difference between enamel and dentin, participants have mixed agreement with a proportion of 61% and 55%, respectively. All the participants agreed these 3D-printed models provide a good caries simulation, are suitable for hands-on operative dentistry courses, and that learning outcomes better than the standard model. The present work shows that rapid prototyping paves the way for customized educational models capable of supporting operative but also preoperative skills. 3D printing opens up new opportunities by reducing the gap between pre-clinical training and clinical reality in caries management, which can positively impact the quality of patient care.

Management of brain aneurysm neck-avulsion during clipping surgery

Background. Intra-operative rupture (IOR) of intracranial aneurysms is a critical event affecting the operation course and the patient’s outcome. However, A rupture induced by an avulsion in the aneurysmal neck is exceedingly challenging, as sealing the neck tear by clip application might result in ischemic injury due to parent vessel occlusion. Here we reviewed the literature regarding the intraoperative avulsion of the aneurysmal neck with an illustrative case to provide explanations of its surgical management intricacies. Methods. A Midline PubMed literature review was performed using the following keywords; (Aneurysm) AND (neck) AND (surgery or clipping) AND (tear OR avulsion). Fifty-three results were found initially. After excluding non-human subject studies, and non-English studies, two independent researchers examined the title and the abstract for the cases of neck tear or avulsion with its management. Results. Fourteen articles were found to be included in this study. The average age of the cases is around 57 years. The percentages of females in the review were 62% (8/13), and among the males, 38% (5/13). Regarding the locations, PcomA and AcomA were both 23% (3/13) of the cases; other locations include ACA, 15%, and MCA, 15%. The surgical techniques that opted from the literature include the cotton clip method, clip wrapping, parallel clipping and micro-suturing Conclusion. IOR due to aneurysmal neck avulsion is a devastating surgical complication, and its management may differ according to the extent of the rupture. Choosing the most convenient technique depends on the surgeon’s knowledge and experience.

Musculoskeletal Complaint Epidemiology inAustralian Special Operation Forces Trainees.

Elite military trainees are burdened by high numbers of musculoskeletal (MSK) injuries and are a priority military population for injury prevention. This research aims to describe the MSK complaint epidemiology of trainees undertaking special forces (SF) training in the Australian Defence Force (ADF). One barrier to accurate injury surveillance in military populations is that traditional surveillance methods rely on personnel engaging with the military healthcare system to collect injury data. This approach is likely to underestimate the injury burden as it is known that many military personnel, particularly trainees, avoid reporting their injuries because of various motives. Subsequently, the insights from surveillance systems may underestimate the injury burden and limit the ability to inform prevention requirements. This research aims to actively seek MSK complaint information directly from trainees in a sensitive manner to mediate injury-reporting behaviors. This descriptive epidemiology study included two consecutive cohorts of ADF SF trainees from 2019 to 2021. Musculoskeletal data items and their respective recording methods were based on international sports injury surveillance guidelines and adapted to a military context. Our case definition encompassed all injuries or physical discomforts as recordable cases. A unit-embedded physiotherapist retrospectively collected MSK complaint data from selection courses and collected prospective data over the training continuum. Data collection processes were external to the military health care system to mediate reporting avoidance and encourage injury reporting. Injury proportions, complaint incidence rates, and incidence rate ratios were calculated and compared between training courses and cohorts. In total, 334 MSK complaints were reported by 103 trainees (90.4%), with a complaint incidence rate of 58.9 per 1,000 training weeks (95% CI, 53.0-65.5). Of these MSK complaints, 6.4% (n = 22) resulted in time loss from work. The lumbar spine (20.6%, n = 71) and the knee (18.9%, n = 65) were the most frequently affected body parts. Most of the MSK complaints were reported during selection courses (41.9%), followed by field survival and team tactics (23.0%) and urban operations courses (21.9%). Physical training accounted for 16.5% of complaints. Fast-roping training was associated with more severe MSK complaints. Musculoskeletal complaints are highly prevalent in ADF SF trainees. Complaints are more frequently reported in selection and qualification training courses than in physical training. These activities are priorities for focused research to understand injury circumstances in ADF elite training programs to inform injury prevention strategies. A strength of our study is the data collection methods which have provided greater MSK complaint information than past research; however, much work remains in conducting consistent and accurate surveillance. Another strength is the use of an embedded physiotherapist to overcome injury-reporting avoidance. Embedded health professionals are recommended as continued practice for ongoing surveillance and early intervention.

Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: A pilot study

ObjectivesIntraoperative pancreatoscopy is a promising procedure that might guide surgical resection for suspected main duct (MD) and mixed type (MT) intraductal papillary mucinous neoplasms (IPMNs). The aim of the present study was to assess the diagnostic yield and clinical impact of intraoperative pancreatoscopy in patients operated on for MD and MT-IPMNs. MethodsThis is a retrospective cohort study. Patients undergoing surgery for suspected MD or MT-IPMN underwent intraoperative pancreatoscopy and frozen section analysis. In all patients who required extended resection due to pancreatoscopic findings, we compared the final histology with the results of the intraoperative frozen section analysis. ResultsIn total, 46 patients, 48% females, mean age (range) 67 years (45–82 years) underwent intraoperative pancreatoscopy. No mortality or procedure related complications were observed. Pancreatoscopy changed the operative course in 30 patients (65%), leading to extended resections in 20 patients (43%) and to parenchyma sparing procedures in 10 patients (22%). Analyzing the group of patients who underwent extended resections, 7 (35%) displayed lesions that needed further surgical treatment (six high grade dysplasia and one with G1 pancreatic neuroendocrine tumor) and among those 7, just 1 (14%) would have been detected exclusively with histological frozen section analysis of the transection margin. The combination of both pancreatoscopy and frozen section analysis lead to 86% sensitivity and 92% specificity for the detection of pathological tissue in the remnant pancreas. ConclusionIntraoperative pancreatoscopy is a safe and feasible procedure and might allow the detection of skip lesions during surgery for suspect MD-involving IPMNs.