Data Saves Lives-The U.S. Military Must Build a Real-Time Combat Casualty Care Data Ecosystem for the Future Battlefield.

Large-scale combat operations (LSCO) will challenge the current U.S. military trauma system with high casualty volumes, prolonged evacuation timelines, and degraded logistics.

Echelon of Care at Time of External Fixation and Infection Risk in Military Combat Casualties.

Introduction: Role 2 (R2) U.S. military treatment facilities provide lifesaving far forward damage control resuscitation and surgery.

Breaking point: Musculoskeletal combat injuries in Iraq, Afghanistan, and Syria-Epidemiology and future directions of care on the battlefield after over two decades of war.

Background: The United States has been involved in ongoing combat operations since 2001, the longest period of conflict in the nation's history. This study's intent was to analyze a central Department of Defense casualty database to delineate wound distribution patterns and mechanisms of injury during the conflicts in the Middle East with a particular focus on musculoskeletal injury.

Methods: A retrospective analysis of the Military Orthopedic Trauma Registry was completed for all US service members treated for wounds in the Iraq, Afghanistan, and Syria theater of operations injured between January 1, 2001, and December 31, 2023, who were abstracted into Military Orthopedic Trauma Registry.

A safety and feasibility analysis on the use of cold-stored platelets in combat trauma.

Background: Damage-control resuscitation has come full circle, with the use of whole blood and balanced components. Lack of platelet availability may limit effective damage-control resuscitation. Platelets are typically stored and transfused at room temperature and have a short shelf-life, while cold-stored platelets (CSPs) have the advantage of a longer shelf-life.

The thin red line: Blood planning factors and the enduring need for a robust military blood system to support combat operations.

Battlefield lessons learned are forgotten; the current name for this is the Walker Dip. Blood transfusion and the need for a Department of Defense Blood Program are lessons that have cycled through being learned during wartime, forgotten, and then relearned during the next war. The military will always need a blood program to support combat and contingency operations.

A 20-year retrospective analysis of deep venous thrombosis and pulmonary embolism among combat casualties requiring damage-control laparotomy at US military Role 2 surgical units.

Background: Combat casualties receiving damage-control laparotomy at forward deployed, resource-constrained US military Role 2 (R2) surgical units require multiple evacuations, but the added risk of venous thromboembolism (VTE) in this population has not been defined. To fill this gap, we retrospectively analyzed 20 years of Department of Defense Trauma Registry data to define the VTE rate in this population.

Methods: Department of Defense Trauma Registry from 2002 to 2023 was queried for US military combat casualties requiring damage-control laparotomy at R2.

Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes.

Initial fluid infusion rates for resuscitation of burn injuries typically use formulas based on patient weight and total body surface area (TBSA) burned. However, the impact of this rate on overall resuscitation volumes and outcomes have not been extensively studied. The purpose of this study was to determine the impact of initial fluid rates on 24-hour volumes and outcomes using the Burn Navigator (BN).

APPRAISE-HRI: AN ARTIFICIAL INTELLIGENCE ALGORITHM FOR TRIAGE OF HEMORRHAGE CASUALTIES.

Background: Hemorrhage remains the leading cause of death on the battlefield. This study aims to assess the ability of an artificial intelligence triage algorithm to automatically analyze vital-sign data and stratify hemorrhage risk in trauma patients. Methods: Here, we developed the APPRAISE-Hemorrhage Risk Index (HRI) algorithm, which uses three routinely measured vital signs (heart rate and diastolic and systolic blood pressures) to identify trauma patients at greatest risk of hemorrhage.

The Battle of the Titans-Comparing Resuscitation Between Five Major Burn Centers Using the Burn Navigator.

The goal of burn resuscitation is to provide the optimal amount of fluid necessary to maintain end-organ perfusion and prevent burn shock. The objective of this analysis was to examine how the Burn Navigator (BN), a clinical decision support tool in burn resuscitation, was utilized across five major burn centers in the United States, using an observational trial of 300 adult patients. Subject demographics, burn characteristics, fluid volumes, urine output, and resuscitation-related complications were examined.

Battlefield pain summit 2022: Expert consensus statements.

Background: Battlefield pain occurs in combat casualties who experience multiple severe injuries. The nature of battlefield scenarios requires a distinct approach to battlefield pain research. A battlefield pain summit was thus convened to identify shortcomings in the current understanding of battlefield pain management, review the current state of battlefield pain research, and shape the direction of future research.

Using a Normothermia Bundle With Perioperative Prewarming to Reduce Patient Hypothermia.

Purpose: To determine if implementing a normothermia bundle, which includes preoperative forced-air warming blankets, reduces incidence of inadvertent perioperative hypothermia (IPH).

Design: Intervention study using retrospective chart review.

Methods: Patients received a preoperative forced-air warming blanket and temperature management with the normothermia bundle.

Abdominal Surgical Patients Randomized to Aromatherapy for Pain Management.

Purpose: Evaluate aromatherapy for postoperative abdominal pain in hospitalized patients.

Design: A randomized controlled trial design.

Methods: Study participants (n = 172) were randomized to receive either standard care or standard care and aromatherapy (AT) for postsurgical pain up to 24 hours after admission to a nonintensive care surgical unit.

The Role of the Human Microbiome in Chemical Toxicity.

There is overwhelming evidence that the microbiome must be considered when evaluating the toxicity of chemicals. Disruption of the normal microbial flora is a known effect of toxic exposure, and these disruptions may lead to human health effects. In addition, the biotransformation of numerous compounds has been shown to be dependent on microbial enzymes, with the potential for different host health outcomes resulting from variations in the microbiome.

Alterations in tissue microRNA after heat stress in the conscious rat: potential biomarkers of organ-specific injury.

Background: Heat illness remains a significant cause of morbidity in susceptible populations. Recent research elucidating the cellular mechanism of heat stress leading to heat illness may provide information to develop better therapeutic interventions, risk assessment strategies, and early biomarkers of organ damage. microRNA (miRNA) are promising candidates for therapeutic targets and biomarkers for a variety of clinical conditions since there is the potential for high specificity for individual tissues and unique cellular functions.

A Comparison of Aromatherapy to Standard Care for Relief of PONV and PDNV in Ambulatory Surgical Patients.

Purpose: To determine effectiveness of aromatherapy (AT) compared with standard care (SC) for postoperative and postdischarge nausea and vomiting (PONV/PDNV) in ambulatory surgical patients.

Design: Prospective randomized study.

Methods: Patients (n = 254) received either SC or AT for PONV and interviewed for effectiveness of PDNV.

Potential and Actual Health Hazards in the Dense Urban Operational Environment: Critical Gaps and Solutions for Military Occupational Health.

: This paper presents environmental health risks which are prevalent in dense urban environments.We review the current literature and recommendations proposed by environmental medicine experts in a 2-day symposium sponsored by the Department of Defense and supported by the Johns Hopkins University Applied Physics Laboratory.Key hazards in the dense urban operational environment include toxic industrial chemicals and materials, water pollution and sewage, and air pollution.

Mining kidney toxicogenomic data by using gene co-expression modules.

Background: Acute kidney injury (AKI) caused by drug and toxicant ingestion is a serious clinical condition associated with high mortality rates. We currently lack detailed knowledge of the underlying molecular mechanisms and biological networks associated with AKI. In this study, we carried out gene co-expression analyses using DrugMatrix-a large toxicogenomics database with gene expression data from rats exposed to diverse chemicals-and identified gene modules associated with kidney injury to probe the molecular-level details of this disease.

Effect of 2 Bedding Materials on Ammonia Levels in Individually Ventilated Cages.

This study sought to identify an optimal rodent bedding and cage-change interval to establish standard procedures for the IVC in our rodent vivarium. Disposable cages were prefilled with either corncob or α-cellulose bedding and were used to house 2 adult Sprague-Dawley rats (experimental condition) or contained no animals (control). Rats were observed and intracage ammonia levels measured daily for 21 d.

Repeated exposure to neurotoxic levels of chlorpyrifos alters hippocampal expression of neurotrophins and neuropeptides.

Chlorpyrifos (CPF), an organophosphorus pesticide (OP), is one of the most widely used pesticides in the world. Subchronic exposures to CPF that do not cause cholinergic crisis are associated with problems in cognitive function (i.e.

Genome-wide gene expression profiling of acute metal exposures in male zebrafish.

To capture global responses to metal poisoning and mechanistic insights into metal toxicity, gene expression changes were evaluated in whole adult male zebrafish following acute 24 h high dose exposure to three metals with known human health risks. Male adult zebrafish were exposed to nickel chloride, cobalt chloride or sodium dichromate at concentrations corresponding to their respective 96 h LC20, LC40 and LC60 (i.e.

Mathematical modeling of the heat-shock response in HeLa cells.

The heat-shock response is a key factor in diverse stress scenarios, ranging from hyperthermia to protein folding diseases. However, the complex dynamics of this physiological response have eluded mathematical modeling efforts. Although several computational models have attempted to characterize the heat-shock response, they were unable to model its dynamics across diverse experimental datasets.

Temporal changes in rat liver gene expression after acute cadmium and chromium exposure.

U.S. Service Members and civilians are at risk of exposure to a variety of environmental health hazards throughout their normal duty activities and in industrial occupations.

Effects of valproic acid and dexamethasone administration on early bio-markers and gene expression profile in acute kidney ischemia-reperfusion injury in the rat.

Renal ischemia-reperfusion (IR) causes acute kidney injury (AKI) with high mortality and morbidity. The objective of this investigation was to ameliorate kidney IR injury and identify novel biomarkers for kidney injury and repair. Under general anesthesia, left renal ischemia was induced in Wister rats by occluding renal artery for 45 minutes, followed by reperfusion and right nephrectomy.

Hydrogen sulfide improves resuscitation via non-hibernatory mechanisms in a porcine shock model.

Background: Hydrogen sulfide (H2S) has been demonstrated to induce a "suspended animation-like" state in rodent models by reversible inhibition of cellular respiration and marked metabolic suppression and has been proposed as a potential pharmacologic adjunct to resuscitation from shock states. There are few data currently available about the mechanisms and efficacy of H2S in larger animals or humans. We examined H2S as a pharmacologic adjunct to resuscitation in a porcine model of severe traumatic shock.