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Introduction Most fighter pilots report cervical pain during their careers. Recommendations for remediation lack evidence. We sought to determine whether regular use of a home cervical traction device could decrease reported cervical pain in F-15C pilots. Methods An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, controlled crossover study was undertaken with 21 male F-15C fighter pilots between February and June 2015. Of the 21 subjects, 12 completed 6 wk each of traction and control, while logging morning, postflying, and post-traction pain. Pain was compared with paired t-tests between the periods, from initial pain scores to postflying, and postflying to post-traction. Results In the traction phase, initial pain levels increased postflight, from 1.2 (0.7) to 1.6 (1.0) Subsequent post-traction pain levels decreased to 1.3 (0.9), with a corresponding linear decrease in pain relative to pain reported postflight. The difference in pain levels after traction compared to initial levels was not significant, indicating that cervical traction was effective in alleviating flying-related pain. Control pain increased postflight from 1.4 (0.9) to 1.9 (1.3). Daily traction phase pain was lower than the control, but insignificant. Discussion To our knowledge, this is the first study of home cervical traction to address fighter pilots' cervical pain. We found a small but meaningful improvement in daily pain rating when using cervical traction after flying. These results help inform countermeasure development for pilots flying high-performance aircraft. Further study should clarify the optimal traction dose and timing in relation to flying.Chumbley EM, O'Hair N, Stolfi A, Lienesch C, McEachen JC, Wright BA. Home cervical traction to reduce neck pain in fighter pilots. Aerosp Med Hum Perform. 2016; 87(12):1010-1015.

Once reserved solely for non-surgical cases, percutaneous ablation is becoming an increasingly popular treatment option for a wider array of patients with small renal masses and the radiation risk needs to be better defined as this transition continues. Retrospective review of our renal tumor ablation database revealed 425 patients who underwent percutaneous ablation for treatment of 455 renal tumors over a 5-year time period. Imparted radiation dose information was reviewed for each procedure and converted to effective patient dose and skin dose using established techniques. Statistical analysis was performed with each ablative technique. For the 331 cryoablation procedures, the mean DLP was 6987 mGycm (SD = 2861) resulting in a mean effective dose of 104.7 mSv (SD = 43.5) and the mean CTDIvol was 558 mGy (SD = 439) resulting in a mean skin dose of 563.2 mGy (SD = 344.1). For the 124 RFA procedures, the mean DLP was 3485 mGycm (SD = 1630) resulting in a mean effective dose of 50.3 mSv (SD = 24.0) and the mean CTDIvol was 232 mGy (SD = 149) resulting in a mean skin dose of 233.2 mGy (SD = 117.4). The difference in patient radiation exposure between the two renal ablation techniques was statistically significant (p

Introduction Many fighter pilots report cervical pain during their careers. Etiology likely relates to +Gz exposure, physical positioning with maneuvers, and varying load associated with headgear. We evaluated whether selected risk factors predicted cervical pain in this population. Methods An Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant, controlled crossover study of the use of home cervical traction was undertaken with 20 male F-15C pilots. We recorded pilot age (mean 38 yr, range 34-49), total high-G hours (2338 h, range 1038-4645), and previous neck problems and measured cervical range of motion. For 12 wk, pilots logged pre- and postflight pain, whether the Joint Helmet Mounted Cueing System (JHMCS) was employed, maximum +Gz experienced, and sortie duration. Pain with and without JHMCS was compared using paired t-tests and correlations assessed with Pearson or Spearman coefficients. Results Mean flight-related pain increased by 0.73 on the numerical rating scale with JHMCS and 0.52 without. Neck extension coupled with JHMCS use correlated negatively with increased pain (r = -0.551). Higher numbers of previously reported neck problems correlated with pain when using JHMCS (r = 0.629). Age, maximum +Gz per sortie, total high-Gz hours flown, and hours per sortie did not correlate. Discussion To our knowledge, this is the first prospective evaluation of risk factors for fighter pilots' cervical pain. Neck pain was significantly worse with JHMCS use and with flexed posture or history of prior neck problems combined with JHMCS use. This information will help guide countermeasure development for high-G pilots.Chumbley EM, Stolfi A, McEachen JC. Risk factors for cervical pain in F-15C pilots. Aerosp Med Hum Perform. 2017; 88(11):1000-1007.

Prolonged chylothorax is a rare, life-threatening, pleural effusion that may be encountered in the setting of trauma. Conservative treatment may be successful and is the traditional approach in cases of limited chyle output. Early surgical intervention is required in cases with large refractory chyle output, but may be associated with substantial morbidity and mortality. Percutaneous thoracic duct embolization is an uncommon, minimally invasive, safe and effective treatment alternative. We report a case of successful thoracic duct embolization to treat large-volume chylothorax due to blunt trauma.

A patient with systemic mastocytosis underwent a FDG-PET/CT scan. CT demonstrated loss of corticomedullary differentiation in the axial skeleton and thickening of cortical bone in the appendicular skeleton consistent with myelofibrosis and osteosclerosis. Remarkably, the bones of the lower

INTRODUCTION Recent physiological incidents involving pilots of high performance fighter aircraft have raised the question of whether inadvertent, short bursts of significantly reduced oxygen could negatively impact real-time performance. This study evaluated normobaric, real-time performance in the setting of transient near-anoxia to inform future countermeasure development. METHODS The study was performed on 12 healthy subjects without significant medical history. Following collection of baseline data, real-time performance changes were evaluated during sequentially increasing periods of near-anoxic gas exposure (F(I)0(2) = 1%) using a computer-based performance assessment tool. Both room air and 100% oxygen were used as the prebreathe/recovery gases. Statistical analysis was performed on the results. RESULTS Under normobaric conditions, subjects inspiring up to five near-anoxic breaths showed no significant performance decrement in either accuracy or effective actions per minute. Mean accuracy up to five near-anoxic breaths was 0.67 (SD = 0.01) as compared to a baseline mean of 0.68 (SD = 0.02). Hyperoxia had a protective effect on subject physiological response to near anoxia. DISCUSSION These normobaric findings offer an assessment of real-time performance changes in the setting of transient, near-anoxic gas exposure. Overall, the results help inform the design of increasingly complex aircraft oxygen delivery systems in terms of how tightly such systems must match the sea-level gas equivalent with increasing altitude. This is particularly relevant as such systems are being called upon to ensure safe aircrew operations across an expanding operational flight envelope.

Rationale and Objectives. Digitizing images for use in case presentations based on hardcopy films, slides, photographs, negatives, books, and videos can present a challenging task. Scanners and digital cameras have become standard tools of the trade. Unfortunately, use of these devices to digitize multiple images in many different media formats can be a time-consuming and in some cases unachievable process. The authors’ goal was to create a PC-based solution for digitizing multiple media formats in a timely fashion while maintaining adequate image presentation quality. Materials and Methods. The authors’ PC-based solution makes use of off-the-shelf hardware applications to include a digital document camera (DDC), VHS video player, and video-editing kit. With the assistance of five staff radiologists, the authors examined the quality of multiple image types digitized with this equipment. The authors also quantified the speed of digitization of various types of media using the DDC and video-editing kit. Results. With regard to image quality, the five staff radiologists rated the digitized angiography, CT, and MR images as adequate to excellent for use in teaching files and case presentations. With regard to digitized plain films, the average rating was adequate. As for performance, the authors recognized a 68% improvement in the time required to digitize hardcopy films using the DDC instead of a professional quality scanner. Conclusions. The PC-based solution provides a means for digitizing multiple images from many different types of media in a timely fashion while maintaining adequate image presentation quality.

Inferior vena cava (IVC) pseudoaneurysms are rare clinical entities with an uncertain natural history due to limited follow-up information. This case report describes a 30-year-old woman with two IVC pseudoaneurysms and their associated anatomy. It also details our treatment plan, with follow-up through radiographic resolution of the pseudoaneurysms. To our knowledge, this is the first case report to document a patient with two pseudoaneurysms of the IVC and full resolution treated by nonoperative management.

Duplication of an extracranial internal carotid artery, a retropharyngeal carotid transposition, an aberrant internal carotid artery in the middle ear, and a persistent stapedial artery are each individually uncommon vascular variants. In this case report, we discuss a rare occurrence of all four of these variants in a single individual who presented to our emergency department with a complaint of dizziness and a recent fall. Included in the discussion is pertinent embryology and clinical associations.

Digitizing images for use in case presentations based on hardcopy films, slides, photographs, negatives, books, and videos can present a challenging task. Scanners and digital cameras have become standard tools of the trade. Unfortunately, use of these devices to digitize multiple images in many different media formats can be a time-consuming and in some cases unachievable process. The authors' goal was to create a PC-based solution for digitizing multiple media formats in a timely fashion while maintaining adequate image presentation quality.The authors' PC-based solution makes use of off-the-shelf hardware applications to include a digital document camera (DDC), VHS video player, and video-editing kit. With the assistance of five staff radiologists, the authors examined the quality of multiple image types digitized with this equipment. The authors also quantified the speed of digitization of various types of media using the DDC and video-editing kit.With regard to image quality, the five staff radiologists rated the digitized angiography, CT, and MR images as adequate to excellent for use in teaching files and case presentations. With regard to digitized plain films, the average rating was adequate. As for performance, the authors recognized a 68% improvement in the time required to digitize hardcopy films using the DDC instead of a professional quality scanner.The PC-based solution provides a means for digitizing multiple images from many different types of media in a timely fashion while maintaining adequate image presentation quality.

In [2] it was shown that, for many specifications of engineering interest, linear controller design is a convex optimization problem. For a simple plant, and for two robustness measures and an RMS noise merit figure, Barratt and Boyd used convex optimization in [4] to compute performance trade off curves showing the best performance achievable with any linear singlerate digital controller. In this paper show how the theory of multi-rate lifts and convex optimization can be used to calculate linear multi-rate performance tradeoff curves for the same plant considered in [4]. The performance differences that can be obtained with multi-rate sampling are exposed, and a simple exact comparison between multi-rate and single-rate sampling is possible.