Civilian and detainee orthopaedic surgical care at an Air Force theater hospital

This study is a retrospective analysis of the orthopaedic care rendered to Iraqi citizens, both military and civilian, and detainees in Balad, Iraq, at an Air Force theater hospital. Defining the scope of care for this patient group and emphasizing the differences in care provided for the endemic population in contrast to the rapidly air-evacuated Coalition injured combatant are the primary focus of the study. Approximately 50% of more than 1600 trauma/combat-related injury admissions to Air Force Theater Hospital in Balad, Iraq, from the period of September 2, 2005 through January 18, 2006, were Iraqi citizens and detainees. The care rendered to this population differed from the care given to a rapidly air-evacuated patient in that definitive care of all combat wounds, including fracture care and soft tissue management, was the responsibility of the deployed surgeons. Open reduction and internal fixation, definitive debridement, Wound VAC placement (Vacuum-Assisted Closure Device; KCI International, San Antonio, Tex), and final soft tissue management were performed at Air Force Theater Hospital. All patients were treated according to their injuries, including detainees, who received the same level of care as any other injured patient. This article will depict examples of the civilian and detainee orthopaedic care available and performed in a war zone and how that care differed from that rendered to a rapidly evacuated American combatant. Injured Coalition combatants received high-level damage control orthopaedic care and initial debridements, with external fixation as the single most common means of long-bone fracture stabilization. Civilians and detainees seen at Balad received the same high-level care and much, if not all, of their definitive care while at Air Force Theater Hospital. The care rendered to Iraqi citizens and detainees at an Air Force theater hospital is described, with multiple case examples that reflect a high level of definitive care offered in a war zone.     

Biodegradation of Aromatic Compounds: An Overview of Meta-Fission Product Hydrolases

Meta fission product (MFP) hydrolases catalyze hydrolysis of a low reactive carbon-carbon bond found in meta-fission products, generated during biodegradation of various aromatic compounds. These enzymes belong to the alpha/beta hydrolase super family and show structural conservation despite having poor sequence similarity. MFP-hydrolases are substrate specific and studies have indicated that this substrate specificity plays a key role in the determination of the organism's ability to degrade a particular substrate. In this concise review of MFP-hydrolases we discuss their classification, biochemical properties, the molecular basis of their substrate specificity, their catalytic mechanism, and evolutionary significance.     

Incorporating respondent-driven sampling into web-based discrete choice experiments: preferences for COVID-19 mitigation measures

Health Services and Outcomes Research Methodology - To slow the spread of COVID-19, most countries implemented stay-at-home orders, social distancing, and other nonpharmaceutical mitigation...     

The Problem of the Accuracy of Intraoperative Examination of Axillary Sentinel Nodes in Breast Cancer

Background: Sentinel node SN biopsy has become accepted as a reliable method of predicting the state of the axilla in breast cancer. The key issue, however, is the accuracy of the pathological evaluation of the biopsied node, which should be done intraoperatively whenever possible.Methods: In our initial experience on 192 patients using a conventional intraoperative frozen section method, the false-negative rate was 6.3%, and the negative predictive value was 93.7%. We devised a new and exhaustive intraoperative method, requiring about 40 minutes, in which pairs of sections are taken every 50 for the first 15 sections and every 100 thereafter, sampling the entire node. Sentinel node metastases were found in 143 of the 376 T1N0 cases examined 38%.Results: Metastases were always identified on hematoxylin and eosin sections, although in 4% of cases, cytokeratin immunostaining on adjacent sections was useful for confirming malignancy. In 233 patients the SNs were disease-free; of these patients, 222 had metastasis-free axillary nodes, and 11 4.7% had another metastatic node.Conclusion: Extensive intraoperative examination of frozen sentinel nodes correctly predicts an uninvolved axilla in 95.3% of cases negative predictive value. This method is, therefore, suitable for identifying patients in whom axillary dissection can be avoided.