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Lan is a high prevalence red blood cell antigen present in the majority of the populations that belong to the Lan (Langereis) blood group system. Anti-Lan antibody is an immunoglobulin G (IgG) antibody that is known to cause delayed hemolytic transfusion reactions in adults as well as hemolytic disease in fetuses and newborns, however with variable clinical significance ranging from mild to severe. We present a 58-year-old woman with diffuse abdominal pain and a large gastric ulcer causing gastric outlet obstruction. She underwent antrectomy and Billroth I reconstruction surgery without complications. The patient's hemoglobin upon presentation was 10g/dL and dropped acutely post-operatively to 6.4 g/dL requiring blood transfusion. The patient developed acute respiratory distress within minutes of starting a packed red blood cell (pRBC) transfusion, requiring discontinuation. Laboratory testing demonstrated pan-reactivity with additional reference testing demonstrating an anti-Lan antibody. Selleck AZ191 The rarity of Lan negative pRBC units is a challenge in managing such patients requiring blood transfusions. Autologous blood donation or donation by a compatible family member is another option to consider in these rare cases.Non-cardiac chest pain (NCCP) is a very common and functionally limiting pain complaint that vexes patients and medical providers leading to time-consuming and expensive diagnostic work-ups as well as significant disability and lost productivity. Despite extensive debate and research, there is no definitive treatment recommendation or high-level evidence to support a conservative care treatment approach, or interventional management procedures for the diagnosis and alleviation of NCCP. In patients presenting with chest pain, after ruling out life-threatening causes, the diagnosis of NCCP is made. This process is a diagnosis of exclusion rather than a specific etiology with a defined treatment plan. This results in specialty consultation, advanced diagnostic testing, and delayed definitive care. A better triage process may include the incorporation of diagnostic maneuvers at the primary care and emergency room to justify referral to a musculoskeletal specialist in lieu of or during advanced diagnostic work-up. After the diagnosis of NCCP is made in our young and active patient population, we have seen significant success in the application of manipulation and a functional restoration program similar to the presented case. To our knowledge, this treatment approach has not been previously described. While this management strategy may be taught in physiotherapy courses, we provide the case to illustrate a multimodal treatment approach that seems to be unknown or underutilized based on the number of referrals and prevalence of this condition.Introduction Suicide is the 10th leading cause of death in the United States (US) and the prevalence continues to increase. It is estimated that there is an average of 25 attempted suicides for every suicide death in the US, and the economic burden of suicide and attempted suicide is high. Identification of those at risk for suicide and attempted suicide can help with early and prompt intervention. Studies in Europe and Asia have shown that there is a relationship between seasonal patterns and suicidal risk. However, little is known about seasonal patterns of suicidal attempts in the US. Therefore, our study aimed to assess seasonal patterns by days of the week and months of the year in the US. Methods Hospitalized adult patients with suicide attempts and self-inflicted injury were identified using the discharge data from the National Inpatient Sample (NIS) from January 1, 2010 to December 31, 2014. We looked at the seasonal trends of patients with attempted suicide and self-inflicted injury by weekday vs weejury is a very important step towards developing effective strategies to prevent suicide and attempted suicide.Osteoarthritis is a prominent cause of disability in older adults, especially with an increasingly obese and aging population. Clinical management of pain secondary to osteoarthritis should focus on education and self-management with exercise and weight management as a priority. Surgical intervention should only be considered once conservative measures have failed. This review provides a clinical update on the pathogenesis, diagnosis, and management of osteoarthritis.
Leadership amongst professional organizations is a key opportunity for scholarly activity which is essential for academic advancement. Our objective was to examine the differences between men and women in leadership within surgical organizations.

Credentials were obtained through an internet search. Variables included organization type, leadership role, gender, advanced degree, medical school graduation year, and publications. A bivariate analysis was performed between genders. A p-value <0.05 was considered statistically significant.

Five hundred forty-three leaders were identified in 43 surgical organizations. There was a significant difference in the number of male and female leaders (72.7% vs 27.3%, p=0.016). Women were most likely to hold the role of "Other", which consisted of lower-level leadership roles including committee chair positions and resident and medical student delegates (35.5%). Fewer women had publications (85.8% vs 92.9%, p=0.01), more women had advanced degrees (24.5% vs 17.0%, p=0.049), and women were involved earlier in their careers (5.9 years, 95% CI 4.1-7.7 years, p<0.001) than their male colleagues.

Gender disparity in leadership of surgical organizations exists. Women are involved earlier in their careers and hold lower-level leadership positions reflecting potential for increased involvement in high-level leadership roles in the future. Data need to be trended to discern if women in surgical organizations rise within leadership roles as more women continue to enter surgical subspecialties.
Gender disparity in leadership of surgical organizations exists. Women are involved earlier in their careers and hold lower-level leadership positions reflecting potential for increased involvement in high-level leadership roles in the future. Data need to be trended to discern if women in surgical organizations rise within leadership roles as more women continue to enter surgical subspecialties.
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