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Volume 6 ， Issue 1 ， 2019
- Abstract：The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People’s Liberation Army（PLA）. An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus. At Level Ⅰfacilities, tension pneumothorax and open pneumothorax are recommended for initial assessment during the first aid stage. Re-evaluation and further treatment for hemothorax, flail chest, and pericardial tamponade are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, simple surgical operations such as emergency thoracotomy and debridement surgery for open pneumothorax are recommended. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.7|20|2Updated：2022-12-27
- Abstract：A wide spectrum of scenarios may lead to radiation incidents and the liberation of radioactive material. In the case of a terrorist attack by a "dirty bomb", there is a risk of mechanical and thermal trauma, external irradiation, superficial contamination and incorporation of radioactive material. The first treatment priority must be given to the care of trauma patients with life-threatening injuries, as the health effects of radiation occur with latency. Radionuclide incorporation will lead to a longer-lasting irradiation from inside the body, associated with a higher risk of stochastic radiation effects（e.g., occurrence of tumors） in the long run. It must be expected that victims with potentially incorporated radionuclides will far outnumber trauma patients. The elimination of radionuclides can be enhanced by the administration of decorporation agents such as（Ca） Diethylenetriaminepentaacetic acid（DTPA） or Prussian blue,reducing the radiological burden of the body. There is still no consensus whether decorporation treatment should be started immediately based only on a suspicion of radionuclide incorporation（"urgent approach"） or if the results of internal dosimetry confirming the necessity of a treatment should be awaited, accepting the delay caused by the measurements and computations（"precautionary approach"）. As the therapeutic effectiveness may be substantially decreased if treatment initiation is delayed only by several days, depending on the radionuclide, the physicochemical properties of the compounds involved and the route of absorption, we favor an "urgent approach" from a medical point of view. In doubt, it seems justified to treat victims by precaution, as the adverse effects of the medication seem minimal. However, in the case of a high number of victims, an "urgent treatment approach" may require a large number of daily doses of antidotes, and therefore, adequate investments in preparedness and antidote stockpiling are necessary.4|7|0Updated：2022-12-27
- Abstract：Background: In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and noncompressible torso injury（NCTI）.Methods: We completed a retrospective review of MEDEVAC patient care records for United States military personnel who sustained traumatic amputations and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NCTI（AMP+NCTI）, traumatic amputation only（AMP）,and neither AMP nor NCTI（Non-AMP/NCTI）. Analysis was performed using chi-squared tests, Fisher’s exact tests,Cochran-Armitage Trend tests, Shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and Cox proportional hazards regression modeling.Results: We reviewed 1267 records, of which 669 had an injury severity score（ISS） of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries（n=104, AMP only）, 10.8% sustained amputation and NCTI（n=72, AMP+NCTI）, and 73.7% did not sustain either an amputation or an NCTI（n=493,Non-AMP/NCTI）. AMP+NCTI had the highest mortality（16.7%） with transport time greater than 60 min. While the AMP+NCTI group had decreasing survival with longer transport times, AMP and Non-AMP/NCTI did not exhibit the same trend.Conclusions: A decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NCTI. No significant association between transport time and outcomes was found in patients who did not sustain NCTI. Priority for rapid evacuation of combat casualties should be given to those with NCTI.4|3|1Updated：2022-12-27
- Abstract：Background: Acute mountain sickness（AMS） is a potentially lethal condition caused by acute hypoxia after ascending to altitudes higher than 2500 m in a short time. The main symptom of AMS is headache. Numerous risk factors of AMS have been examined, including gender, obesity, ascent rate, age and individual susceptibility. In previous studies, age was considered a predisposing factor for AMS. However, different opinions have been raised in recent years. To clarify the association between AMS and age, we conducted this meta-analysis.Methods: We obtained observational studies that explored risk factors for AMS by searching PubMed, Embase, China National Knowledge Internet（CNKI）, the Wanfang database and CQVIP for articles published before March 2017.The studies included were required to provide the mean age and its standard deviation for subjects with and without AMS, the maximum altitude attained and the mode of ascent. The Lake Louse Score（LLS） or the Chinese AMS score（CAS） was used to judge the severity of AMS symptoms and incidence. Studies were pooled for the analysis by using a random effects model in RevMan 5.0. Meta-regression and subgroup analyses were conducted to identify sources of heterogeneity using Stata 14.2 and RevMan 5.0.Results: In total, 17 studies were included, and the overall number of subjects with and without AMS was 1810 and3014, respectively. The age ranged from 10 to 76 years. Analysis of the 17 included studies showed that age was not associated with AMS（mean difference（MD）=0.10; 95%CI: —0.38-0.58; P=0.69）.Conclusions: This meta-analysis suggests that there is no association between age and the risk of AMS. Race, age,and ascent mode are common sources of heterogeneity, which may provide an analytical orientation for future heterogeneity analyses.4|8|1Updated：2022-12-27
- Abstract：Background: Research indicates that Posttraumatic stress disorder（PTSD） has an extensive impact on family relationships. Nevertheless, there is a dearth of empirically supported interventions addressing family functioning and PTSD. In the Netherlands, it is considered good clinical practice to offer multi-family therapy（MFT） to veteran and refugee families. MFT for traumatized families aims to address the dysfunctional family patterns that have evolved to address the consequences with trauma.Methods: The aim of this study is to generate a common framework for the practical impact and active ingredients of MFT in families confronted with trauma. The Delphi method was used to study the expert opinion of 11 therapists in Dutch expert trauma institutes.Results: The results indicate that MFT is a promising treatment for families dealing with the consequences of trauma. According to experts, positive outcomes include an increased understanding between family members,particularly visible in the de-escalation of conflicts within the family, and improved parenting. One explanation for the effectiveness of MFT with these target groups is its defining feature of therapy with several families.Conclusions: The findings support the importance of considering family relationships and the family context in interventions for traumatized individuals.7|9|0Updated：2022-12-27
- Abstract：Background: The activities carried out by soldiers in the army involve great physical demands and require intense trainings to perform combat-specific tasks. Musculoskeletal injury is a potential threat to the health and physical integrity of the soldier. This study aimed to evaluate the prevalence of lower limb musculoskeletal injuries among soldiers and to propose a training protocol to prevent the most frequent injuries.Methods: This observational（cross-sectional） study recruited a sample of 103 soldiers who required medical attention,from a total 202 new battalion soldiers. The medical records（paper and online） had a form of running text. All data collected were recorded by the registered physicians of the battalion medical post. The records were analyzed by the following variables: medical diagnosis, injury site, mechanism, type of treatment, time loss, existence of previous injury,and recurring injury.Results: A total of 112 musculoskeletal injuries were diagnosed in 71 soldiers, and other types of diseases/injuries were diagnosed in the other soldiers. Joint pain accounted for 55.4% of the diagnoses. The knee was the most affected site, while trauma and overload were the most common mechanisms of injury. Drug treatment was used most frequently, accounting for 58% of the cases. The majority of the sample obtained a temporary leave of absence for1 to 6 days or not at all. Previous injuries and recurrence were not presented as risk factors for injury. With the data received, a protocol for the prevention of injuries to the lower limbs was proposed.Conclusions: This study indicated that the most frequent site of injury is the knee, and joint pain is the most common diagnosis. These results may support the necessity to develop a neuromuscular training protocol to prevent lower limb injuries, which we suggest to be applied in future studies.4|9|1Updated：2022-12-27
- Abstract：Background: The present study was undertaken to determine the effect of different uphill and downhill gradients on cardiorespiratory and metabolic responses of soldiers while carrying heavy military loads in two different modes.Methods: Eight physically fit male soldiers with a mean age 32.0±2.0 years, a mean height of 169.5±4.9 cm, and a mean weight of 63.8±8.4 kg volunteered for this study. Each volunteer completed treadmill walking trials at a speed of 3.5 km/h while carrying no external load, 31.4 kg load in a distributed mode（existing load carriage ensembles） and compact mode（new back pack） over 5 different downhill and uphill gradients（–5%, –10%, 0%, 5%, 10%） for 6 min at each gradient. During the walking trials, heart rate（HR）, oxygen uptake（VO2）, respiratory frequency（RF） and energy expenditure（EE） were determined by the process of breath-by-breath gas analysis using a K4 b2 system. The average of the last 2 min data from each 6 min walking trial for each individual was subjected to statistical analysis.Results: All parameters（HR, VO2, RF, and EE） gradually increased with the change in gradient from downhill to level to uphill. The distributed mode showed higher values compared to compact mode for all gradients, e.g., for VO2, there was a 10.7, 7.4, 5.1, 28.2 and 18.7% increase in the distributed mode across the 5 different gradients.Conclusions: It can be concluded from the present study that the compact mode of load carriage is more beneficial than the distributed mode in terms of cardiorespiratory responses while walking on downhill and uphill surfaces with a 31.4 kg load.4|3|0Updated：2022-12-27
- Abstract：Background: Heavy backpacks are often used by soldiers and firefighters. Weight carrying could reduce the speed and efficiency in task completion by altering the foot sole sensitivity and postural control.Methods: In fifteen healthy subjects, we measured the changes in sensitivity to vibrations applied to the foot sole when standing upright or walking after load carrying（30% body weight）. The participants were asked to judge different vibration amplitudes applied on the 2 nd or 5 th metatarsal head and the heel at two frequencies（25 and 150 Hz） to determine the vibration threshold and the global perceptual representation（Ψ）of the vibration amplitude（Φ）given by the Stevens power function（Ψ=k×Φn）. Any increase in negative k value indicated a reduction in sensitivity to the lowest loads. Pedobarographic measurements, with computation of the center of pressure（COP） and its deviations, were performed during weight carrying.Results: The 25-Hz vibration threshold significantly increased after weight carrying when standing upright or walking.After standing with the added loads, the absolute negative k value increased for the 25 Hz frequency. After walking with the added loads, the k coefficient increased for the two vibration frequencies. Weight carrying significantly increased both the CoP surface and CoP lateral deviation.Conclusions: Our data show that weight carrying reduces the sensory pathways from the foot sole and accentuates the center of pressure deviations.4|4|1Updated：2022-12-27
- Abstract：Despite efforts in prevention and intensive care, trauma and subsequent sepsis are still associated with a high mortality rate. Traumatic injury remains the main cause of death in people younger than 45 years and is thus a source of immense social and economic burden. In recent years, the knowledge concerning gender medicine has continuously increased. A number of studies have reported gender dimorphism in terms of response to trauma, shock and sepsis.However, the advantageous outcome following trauma-hemorrhage in females is not due only to sex. Rather, it is due to the prevailing hormonal milieu of the victim. In this respect, various experimental and clinical studies have demonstrated beneficial effects of estrogen for the central nervous system, the cardiopulmonary system, the liver, the kidneys, the immune system, and for the overall survival of the host. Nonetheless, there remains a gap between the bench and the bedside. This is most likely because clinical studies have not accounted for the estrus cycle. This review attempts to provide an overview of the current level of knowledge and highlights the most important organ systems responding to trauma, shock and sepsis. There continues to be a need for clinical studies on the prevailing hormonal milieu following trauma, shock and sepsis.4|9|3Updated：2022-12-27
- Abstract：AEOL-10150 is a broad-spectrum metalloporphyrin superoxidase dismutase（SOD） mimic specifically designed to neutralize reactive oxygen and nitrogen species. Research has shown that AEOL-10150 is a potent medical countermeasure against national security threats including sulfur mustard（SM）, nerve agent exposure and radiation pneumonitis following a radiological/nuclear incident sufficient to cause acute radiation syndrome（ARS）. AEOL-10150 performed well in animal safety studies, and two completed phase 1 safety studies in patients demonstrated that the drug was safe and well tolerated, indicating that AEOL-10150 has potential as a new catalytic antioxidant drug. In this article, we review improvements in AEOL-10150 in preclinical pharmacodynamic studies, especially regarding anti-SM,chlorine gas and radiation exposure studies.4|10|3Updated：2022-12-27
- Abstract：Background: The pubic region is often involved in accidental hot water or soup-spill burns. Most of these wounds are superficial partial thickness burns. Due to their proximity to the urinary system, as well as vaginal and anal openings,these burns are easily contaminated. Daily dressings are routinely prescribed as the sole treatment. The cumbersome dressing process is uncomfortable and embarrassing for patients. BiobraneTM is a bilayered biosynthetic dressing. Its coverage of superficial partial thickness burns promotes wound healing and allows one-time application.Case presentations: We report two patients who suffered superficial dermal burns over their pubic region. One patient had 23% total body surface area（TBSA） burns over her lower abdomen, both thighs and pubic region. The second patient had 10% TBSA burns that involved her perineum and the medial sides of both thighs and buttocks.Both were managed with the standard resuscitation protocol in the initial phase. Their burn injuries were managed by shaving, Foley catheterization and BiobraneTM coverage. Their wounds healed uneventfully without complications.Full epithelization was achieved by post-operative day seven. Both patients consented to medical photography and academic publication.Conclusions: Shaving and catheterization improved the hygiene of the burns of the pubic area. The BiobraneTMmethod circumvents the need of regular dressing changes, eliminating the pain due to dressing changes and preserving patient dignity.4|13|1Updated：2022-12-27
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