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During the Great War, Canadian military surgeons produced some of the greatest innovations to improve survival on the battlefield. Arguably, the most important was bringing blood transfusion practice close to the edge of the battlefield to resuscitate the many casualties dying of hemorrhagic shock. Dr. L. Bruce Robertson of the Canadian Army Medical Corps was the pioneering surgeon from the University of Toronto who was able to demonstrate the benefit of blood transfusions near the front line and counter the belief that saline was the resuscitation fluid of choice in military medicine. Robertson would go on to survive the Great War, but would be taken early in life by influenza. Despite his life and career being cut short, Robertson’s work is still carried on today by many military medical organizations who strive to bring blood to the wounded in austere and dangerous settings. This article has an Appendix, available at canjsurg.ca

During the Great War, McGill University fielded a full general hospital to care for the wounded and sick among the Allied forces fighting in France and Belgium. The unit was designated No. 3 Canadian General Hospital (McGill) and included some of the best medical minds in Canada. Because the unit had a relationship with Sir William Osler, who was a professor at McGill from 1874 to 1885, the unit received special attention throughout the war, and legendary Canadian medical figures, such as John McCrae, Edward Archibald and Francis Scrimger, VC, served on its staff. The unit cared for thousands of victims of the war, and its trauma care advanced through the clinical innovation and research demanded by the nature of its work. Although No. 3 Canadian General Hospital suffered tragedies as well, such as the deaths of John McCrae and Osler’s only son Revere, by the war’s end the McGill hospital was known as one of the best medical units within the armies in France.

Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions. Conclusion: Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.

Service block time allocation is a critical requirement for the optimization of patient throughput and access to care in the Surgical Services Service Line of the US Army Medical Command. The procedure complexity, volume, and diversity across 25 facilities create significant variation in service block time. This variation requires the involvement of both the informatics and leadership teams for block time allocation to be effective. This article describes our use of the Army’s Surgery Scheduling System, which includes service block time as an embedded function, to develop a standardized process that helps ensure service block time is optimized. We also present guidelines for block time allocation and offer case studies that demonstrate the application of these guidelines.

A crucial chemical link between stars and their orbiting exoplanets is thought to exist. If universal, this connection could affect the formation and evolution of all planets. Therefore, this potential vital link needs testing by characterising exoplanets around chemically-diverse stars. We present the discovery of two planets orbiting the metal-poor, kinematic thick-disk K-dwarf TOI-2345. TOI-2345 b is a super-Earth with a period of 1.05 days and TOI-2345 c is a sub-Neptune with a period of 21 days. In addition to the target being observed in 4 TESS sectors, we obtained 5 CHEOPS visits and 26 radial velocities from HARPS. By conducting a joint analysis of all the data, we find TOI-2345 b to have a radius of \\(1.504+0.047\\\-0.044\\) R\\(_\\) and a mass of \\(3.490.85\\) M\\(_\\); and TOI-2345 c to have a radius of \\(2.451+0.045\\\-0.046\\) R\\(_\\) and a mass of \\(7.27+2.27\\\-2.45\\) M\\(_\\). To explore chemical links between these planets and their host star, we model their interior structures newly accounting for devolatised stellar abundances. TOI-2345 adds to the limited sample of well characterised planetary systems around thick disk stars. This system challenges theories of formation and populations of planets around thick disk stars with its Ultra-Short Period super-Earth and the wide period distribution of these two planets spanning the radius valley.

Troops from the 2nd Battalion of the Royal Irish Regiment are due home from war in Afghanistan later this week. The 100-plus part-time soldiers were at the forefront of the battle against the Taliban becoming the first ever reservists to train the fledgling Afghan National Army on the front line. Writing for the Belfast Telegraph, 2 Royal Irish Commanding Officer, Lt Col ANDREW CULLEN, reflects on the demanding six-month tour Sitting in the comfort of my office I read of 'contacts' with the Taliban in the green zone and days and nights of consistent probing attacks against them by the Taliban. Engagement with the Taliban became an every day occurrence. One report I received read: 'During a nine-day period in early August, patrols were ambushed by the Taliban on five separate occasions.

WOLDAR--Jerome. The Jewish Chapel Fund of the United States Military Academy mourns the loss of our past Vice President, Major General USAF (Ret.

While appreciating very much the place in current journalism for \"task forces,\" I would like to call your attention to an item perhaps overlooked by your task force on hospitals.

GET that message to Garcia.\" This was the terse command given me by Col. Arthur Wagner, head of the Bureau of Military Intelligence of the United States Government, early in 1090. The United States was facing a war with Spain. Col. Wagner had just come from a conference with President McKinley. The President, worn and wearied with the prospect of war. realized the necessity of information regarding the Spanish forces in Cuba and the condition of the insurgent Cuban forces.