Military medicine
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Acute Compartment Syndrome (ACS) is a severe trauma caused by elevated intra-muscle-compartment pressure (ICP). The current standard method for diagnosis is to insert a needle into the muscle sterilely under anesthesia. However, to secure the environment is sometimes not easy and leads to delays in diagnosis. Recently, we have focused on shear wave ultrasound elastography (SWE) as an alternative, which can be done concisely in unclean environment and without anesthesia. We would like to report the usefulness of SWE for ACS diagnosis using 2-pedal walking turkey model recently developed in our lab. ⋯ SWE seems to be a substitute measure of ICP in diagnosing ACS. With regard to our in vivo ACS model using turkey, survival at 50 mmHg ICP for 6 hours and 6 weeks post ACS would be an appropriate situation.
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The initial management of penetrating ocular injuries is a major sight-threatening problem for both civilian and military medicine. A novel device (Eye-Aid) temporarily tamponades leakage from such injuries while being easy to remove upon arrival to specialized ophthalmologic care. Eye-Aid consists of a protective eye shield with an adhesive backing that connects to a portable canister containing rapidly deployable thermoresponsive foam. The aim of this study was to compare the use of the novel Eye-Aid device to control in a new live swine ocular injury model. ⋯ This study describes the first development of an in vivo large animal ocular injury model that realistically approximates the emergent time course and pathophysiology of patients with full-thickness corneal open globe injuries. It also gives the first description of using thermoreversible hydrogel foam for such injuries. Eye-Aid was found to be significantly better than control for treatment of such injuries, based on measurements of both structure and pressure. Assuming that the absence of an ALC-reflex demonstrates complete anterior chamber collapse, the Eye-Aid group demonstrated a 79% eye "save" rate compared to only 14% in the control group, as described earlier. This results in a Number Needed to Treat of 3 for this finding. Eye-Aid additionally demonstrated several characteristics that would be beneficial in a device targeted for emergent deployment by non-ophthalmologists.
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Apoptotic Cell-Based Therapy for the Modification of the Inflammatory Response to Hemorrhagic Shock.
Many trauma patients die from hemorrhagic shock in the military and civilian settings. Although two-thirds of hemorrhagic shock victims die of reasons other than exsanguination, such as the consequent cytokine storm, anti-inflammatory therapies failed to be utilized. Apoptotic cell-based treatments enhance innate ability to exert systemic immunomodulation as demonstrated in several clinical applications and hence might present a novel approach in hemorrhagic shock treatment. ⋯ In a pressure-control hemorrhagic shock model in rats, apoptotic cell infusion showed preliminary signs of a uniform attenuated cytokine response. Apoptotic cell-based therapies might serve as a novel immunomodulatory therapy for hemorrhagic shock.
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Piloting an aircraft is a complex multitasking activity that involves managing information in a nonautomatic way and generates a high workload (psychological, cognitive, and physical) for the pilot. The excess of these demands can result in decreased performance and may impair flight safety. Heart rate variability (HRV) has been used in recent studies as a method to investigate operator's workload in complex environments. This measure can assess the stress and recovery ability of the autonomic nervous system. However, a better understanding of flight influence on the pilot's autonomic modulation is necessary. Therefore, this scoping review aims to systematically map the studies related to changes in the autonomic modulation in military pilots during flight, in order to characterize their workload at different times and flight profiles. ⋯ This scoping review provided insight into the influence of flight on autonomic modulation in military pilots. Some key themes were highlighted: Increased sympathetic activity during flight, sensibility of different domains of HRV to flight demands, and autonomic changes during recovery time. Future research efforts may allow us to enhance the understanding of pilot's workload limits and to elucidate the optimal postflight recovery time.
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After mild traumatic brain injury, service members may experience difficulty with executive functions, which could interfere with return to duty and life roles. Because performance-based multitasking assessments are sensitive to executive dysfunction, a team of military and civilian rehabilitation researchers developed the Charge of Quarters Duty Test (CQDT) to help inform duty readiness after concussion; it is a multitasking test based on a military task scenario that challenges executive functions, such as foresight and planning, set shifting, and prospective memory. Although previous study indicates that CQDT has reliability and known-groups validity, like other multitasking tests, it should not be readministered after rehabilitative care because of learning effects. The purpose of this study was to develop an alternate form of the CQDT and evaluate its equivalence to the CQDT. ⋯ The MODT appears to be an equivalent form of the CQDT that mitigates learning effects that often accompany performance of multitasking assessments. Having developed and validated the equivalence of the CDQT's alternate form, military rehabilitation clinicians have an expanded set of clinical tools by which to identify possible executive dysfunction and evaluate service members' response to rehabilitative care via pre- and post-rehabilitation testing after mild traumatic brain injury.