Military Medicine最新文献

{"title":"Readying Military Medicine for AI-Enabled Warfare.","authors":"Rebekah Cole, Sean Simmons, Joshua Duncan, Jacob Cole, Justin G Peacock","doi":"10.1093/milmed/usaf460","DOIUrl":"https://doi.org/10.1093/milmed/usaf460","url":null,"abstract":"<p><p>Artificial intelligence (AI) is transforming the character of warfare through autonomous systems, real-time data analytics, and algorithmic decision-making, creating new operational, ethical, and clinical challenges for military medicine. While modern battlefields become increasingly shaped by AI-enhanced targeting, autonomous weapons, and contested digital environments, current military medical education and doctrine have not evolved to address these developing threats. This commentary outlines the systemic vulnerabilities that limit military medicine's readiness for AI-enabled large-scale combat operations, including infrastructure gaps, data integrity challenges, cybersecurity threats, and a lack of doctrinal and educational alignment with the evolving battlespace. Drawing from recent conflicts and emerging technologies, we identify critical gaps in trauma training, medical logistics, and ethical preparedness and offers concrete recommendations for reform. Our education and training recommendations include embedding AI-focused scenarios into high-fidelity simulation exercises, training medical personnel in human-AI teaming, and emphasizing data stewardship as a key clinical competency. Through targeted curricular redesign, ethical education, and interdisciplinary collaboration, military medicine can adapt to the demands of AI-driven warfare and ensure operational readiness in future conflicts.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Eagan and Marble.","authors":"Daniel J Hurst","doi":"10.1093/milmed/usaf449","DOIUrl":"https://doi.org/10.1093/milmed/usaf449","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Hurst (Letter to the Editor).","authors":"Sheena M Eagan, Sanders Marble","doi":"10.1093/milmed/usaf451","DOIUrl":"https://doi.org/10.1093/milmed/usaf451","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Localized Pancreatic Cancer among Military Beneficiaries: A National Cancer Database Analysis.","authors":"R Connor Chick, Patrick W Underwood, Robert W Krell, Elizabeth L Barbera, Ryan Heslin, Alex C Kim, Jordan M Cloyd, Joal D Beane, Timothy M Pawlik","doi":"10.1093/milmed/usaf465","DOIUrl":"https://doi.org/10.1093/milmed/usaf465","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic ductal adenocarcinoma outcomes are influenced by sociodemographic factors, including health insurance. Military beneficiaries, which include servicemembers, veterans, and their families, are often treated in civilian settings with TRICARE or Veterans Affairs acting as an insurance payor. We sought to examine outcomes among military and veteran beneficiaries with localized pancreatic cancer treated in civilian hospitals using the National Cancer Database.</p><p><strong>Materials and methods: </strong>Patients age <65 with stage I-III PDAC from 2010 to 2020 with private or other government insurance were included. Stage-stratified overall survival was analyzed using the Kaplan-Meier and multivariate Cox proportional hazards model. Logistic regression models were used to examine receipt of therapy and postoperative mortality. Survival analysis was examined after propensity score matching.</p><p><strong>Results: </strong>Among 21,691 patients meeting inclusion criteria, 781 had other government insurance. Military beneficiaries were more likely than privately insured patients to be male and Black, and to live in low-income and rural areas. They traveled further for care and started treatment later. Furthermore, military beneficiaries were less likely to receive chemotherapy and undergo surgery. After adjusting for clinicopathologic factors, postoperative mortality was higher for military beneficiaries at 30 days (odds ratio 3.51, 95% confidence interval 1.70-7.27) and 90 days (odds ratio 3.36, 95% confidence interval 1.89-5.96). Median overall survival for privately insured patients was 18.5 months versus 14.7 for military (P < .001). Military insurance remained independently associated with worse overall survival (hazard ratio 1.15, 95% CI 1.03-1.29; P = .015). After propensity score matching, stage-stratified overall survival remained inferior for military beneficiaries (P = .004).</p><p><strong>Conclusions: </strong>Among patients with localized pancreatic cancer, military beneficiaries were less likely to receive cancer treatment, had worse postoperative mortality, and experienced worse risk-adjusted overall survival versus individuals with private insurance. Further research is needed to investigate potential disparities in access to care and treatment outcomes among military beneficiaries and to evaluate policies aimed at closing this gap.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Self-Reported Intake Versus Military Dietary Reference Intakes in Deployed Special Operations Forces Soldiers.","authors":"Jacqueline A Garcia, Nicholas D Barringer, Beatriz George, Harris R Lieberman, William R Conkright","doi":"10.1093/milmed/usaf453","DOIUrl":"https://doi.org/10.1093/milmed/usaf453","url":null,"abstract":"<p><strong>Background: </strong>Special Operations Forces (SOF) Soldiers are elite warfighters who have high nutritional requirements based on the rigorous nature of their training and deployments. Inadequate nutrition can lead to diminished health and performance. Energy and nutrient guidelines for military personnel are defined in the Military Dietary Reference Intakes (MDRI). It is not known if SOF Soldiers meet the MDRIs during deployment when physical demands are high and access to quality nutrition may be limited. The objective of this study was to compare self-reported intake with established MDRIs in SOF personnel during a deployment in an austere environment.</p><p><strong>Materials and methods: </strong>This was a cross-sectional study who was conducted at the end of a 6-month deployment in Afghanistan. Active duty SOF male Soldiers (n = 40) were administered a 2014 Block Food Frequency Questionnaire to assess food intake during the deployment. Self-reported nutrient intake was compared to the MDRIs using one sample t-tests.</p><p><strong>Results: </strong>Self-reported intake of energy, carbohydrate, fiber, vitamin D, and potassium were significantly lower than the MDRIs (P < .001). Intake of fat and protein met the MDRIs (P > .05), although B vitamins, calcium, phosphorus, iron, and sodium all exceeded the MDRIs (P ≤ .001). Relative to body mass, average energy intake was 28.9 kcal/kg, carbohydrate was 3.2 g/kg, protein was 1.3 g/kg, and fat was 1.2 g/kg.</p><p><strong>Conclusions: </strong>Deployed SOF Soldiers may under consume energy and key nutrients, which could jeopardize health, performance, and operational readiness. Tailored nutrition interventions with consideration of operational demands and food/supplement accessibility may be needed to optimize energy and nutrient intake in austere environments.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Vascularized Fibular Autograft for Two-Stage Scapulohumeral Arthrodesis in Ballistic Shoulder Injuries: A Case Series and Review.","authors":"Bernard de Geofroy, Geoges Pfister, Christophe Andro, Camille Choufani, Cyril Lemé, Laurent Mathieu, Ammar Ghabi","doi":"10.1093/milmed/usaf362","DOIUrl":"https://doi.org/10.1093/milmed/usaf362","url":null,"abstract":"<p><strong>Background: </strong>Ballistic trauma to the proximal humerus poses a significant challenge because of extensive bone loss and soft tissue damage, often involving the rotator cuff, deltoid muscle, and axillary nerve. In cases where limb preservation is the priority, scapulohumeral arthrodesis (SHA) remains a viable option, particularly when prosthetic reconstruction is contraindicated because of severe musculotendinous injury. The Masquelet 2-stage induced membrane technique has shown promising results in lower limb reconstruction, yet its application for upper limb arthrodesis in ballistic injuries remains underreported. This study aims to evaluate the outcomes of SHA using a non-vascularized fibular autograft in a 2-stage reconstruction approach following severe ballistic trauma.</p><p><strong>Materials and methods: </strong>This retrospective, multicentric case series included 4 male patients (mean age: 42 years, range: 30-52) treated between 2022 and 2023 for proximal humeral ballistic trauma. Inclusion criteria were significant humeral bone loss (>10.5 cm), rotator cuff and deltoid damage, and axillary nerve dysfunction. Exclusion criteria included scapular involvement and brachial plexus injuries beyond the axillary nerve. The first stage of the Masquelet technique involved radical debridement, resection of necrotic bone, and placement of an antibiotic-laden cement spacer. The second stage, performed 6 weeks later, involved removal of the cement, placement of a perforated non-vascularized fibular autograft, and stabilization with a scapulohumeral plate. Corticocancellous grafting from the iliac crest and femoral head allograft was used to enhance consolidation.</p><p><strong>Results: </strong>At the 1-year follow-up, all patients demonstrated significant functional improvement. The Constant score showed a substantial increase compared to preoperative values. Pain, assessed by the Visual Analog Scale (VAS), decreased both at rest and during movement. Radiographic analysis confirmed bone consolidation at a mean of 7 months (range: 6-11 months). No cases of recurrent infection or graft failure were observed. One patient required targeted antibiotic therapy because of positive microbiological cultures, but no clinical infection developed. Patient satisfaction was high, with an average rating of 8.5/10.</p><p><strong>Conclusions: </strong>Two-stage SHA using a non-vascularized fibular autograft may represent a viable treatment option for proximal humeral ballistic trauma with extensive bone and soft tissue damage, particularly in settings where microsurgical expertise is not available. Despite the encouraging early outcomes observed in this small series, further prospective studies with larger cohorts and longer follow-up are needed to validate this approach and assess its long-term efficacy and safety.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Backpack Load Carriage Affects Motor and Sensory Responses of the Median Nerve.","authors":"Jennifer L Hein, Katherine Saul, Deanna J Schmidt","doi":"10.1093/milmed/usaf459","DOIUrl":"https://doi.org/10.1093/milmed/usaf459","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Use of the upper limbs is often necessary for military and firefighter personnel who carry backpacks. Backpack straps can compress the brachial plexus nerves of the upper limb. It is known that carrying a backpack can lead to rucksack palsy, but it is unknown if effects of upper limb nerve compression from carrying a heavy backpack can be demonstrated after a single session of backpack use. Our study aimed to investigate the short-term effects of backpack carriage on upper limb nerve conduction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Thirty-six participants including 18 female (mean ± SD: age 24.3 ± 7.6 years; height 168.8 ± 9.4 cm; mass 73.1 ± 16.6 kg; BMI 25.4 ± 4.5 kg/m2) and 18 male (24.1 ± 5.8 years; 178.2 ± 9.4 cm; 80.2 ± 11.7 kg; BMI 25.0 ± 4.3 kg/m2) were recruited as a convenience sample and assessed by nerve conduction study (NCS) of the median nerve on the dominant upper limb. Skeletal muscle mass (SMM) and body mass index (BMI) were evaluated using bioelectric impedance. Nerve conduction study measurements were taken before (PRE), after 20 minutes of walking and while still wearing a military-style large frame backpack with hip belt loaded to 30% bodyweight (POST), and immediately after removing the backpack (DOFF). We analyzed comparisons statistically using mixed factor analysis of variance (ANOVA) with significance level of P &lt; .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Motor nerve action potential amplitude significantly decreased when stimulation was at the axilla from PRE to POST (P = .025) and PRE to DOFF (P = .012). Motor nerve action potential latency was significantly increased PRE to POST and PRE to DOFF with stimulation at the elbow (P = .029 and P = .030, respectively). Latency was significantly longer for males as compared to females (P ≤ .008). Sensory nerve action potential amplitude decreased significantly between PRE and POST (P = .007). Significant correlation was determined between amount of SMM and percent difference PRE to POST in motor nerve action potential amplitude (r = 0.438, P &lt; .01). Participants with lower SMM demonstrated greater difference in motor nerve action potential after backpack carriage with POST measurements lower than PRE measurements. Body mass index was significantly correlated with sensory baseline-to-peak amplitude percent difference PRE to POST (r = 0.428, P &lt; .01) indicating that those with lower BMI had a larger negative impact on sensory nerve response after backpack carriage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The results of this study reveal that walking for 20 minutes while carrying a 30% bodyweight backpack resulted in an increase in upper limb motor nerve latency and decrease in sensory and motor nerve action potential amplitude. The NCS findings indicate that SMM may have a protective effect and was therefore beneficial to maintaining upper limb nerve conduction after backpack carriage while lower BMI was a risk factor for reduced sensory nerve ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exertional Heat Illness Recovery and Recurrence.","authors":"Josh B Kazman, D Alan Nelson, Anwar E Ahmed, Patricia A Deuster, Francesca P Cariello, Francis G O'Connor, James D Mancuso, Stephen A Lewandowski","doi":"10.1093/milmed/usaf429","DOIUrl":"https://doi.org/10.1093/milmed/usaf429","url":null,"abstract":"<p><strong>Introduction: </strong>Exertional heat illness (EHI) is a threat to force health and readiness. EHI recovery can entail lengthy periods of lost duty time as providers ensure that patients have completely recovered and that the risk for recurrent EHI is low. Although EHI recurrence is a common concern, there is little research to inform or predict EHI recurrence. Here we describe characteristics associated with EHI duty restrictions and use them to predict EHI recurrence and prognosis.</p><p><strong>Materials and methods: </strong>We studied a retrospective cohort of 1,742 US Army soldiers who received EHI duty restrictions because of a recent EHI diagnosis between July 2014 and April 2017. We used EHI complications, medical history, and demographics to predict EHI recurrence. The study protocol was approved by the Naval Medical Center Portsmouth Institutional Review Board.</p><p><strong>Results: </strong>4.4% of soldiers had recurrent EHI. Among soldiers receiving an EHI profile, a history of another prior EHI was rare (5.6%) but was strongly associated with recurrent EHI (HRadj: 7.37, 95% CI: 4.24-12.81). These associations were consistent across heat exhaustion (HE), heat injury (HI), and heat stroke (HS) cases. Shorter profile durations were associated with reduced risk for recurrence, but this association was mostly attributable to milder EHI events. Based on total duty restriction days, HI represented a greater disease burden than HS or HE. Recurrent EHI was more common among soldiers who had been on an HI (4.6%) or HS (6.1%) profile than an HE profile (3.7%), although these differences were not statistically significant. Clinical complications (e.g., kidney injury, rhabdomyolysis, respiratory/cardiovascular distress, inpatient/ICU admission) were not associated with EHI recurrence.</p><p><strong>Conclusions: </strong>Among soldiers on EHI duty restrictions, prior EHI is rare but strongly associated with risk for yet another EHI. The clinical characteristics (e.g., profile duration, complications) of a prior EHI were not associated with risk for recurrent EHI. Further research should characterize the role of EHI severity in return to duty and validate HI as a diagnostic category.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Heart Rate Variability and Exertional Task Completion During Recovery of Mild Traumatic Brain Injury in Active Duty Service Members.","authors":"Julianna H Prim, Maria I Davila Hernadez, Wesley Cole, Amy S Cecchini, Shabbar I Ranapurwala, Karen L McCulloch","doi":"10.1093/milmed/usaf454","DOIUrl":"https://doi.org/10.1093/milmed/usaf454","url":null,"abstract":"<p><strong>Introduction: </strong>Primary care exertional testing is recommended for mild traumatic brain injury (mTBI) management in active duty service members (ADSM) before return-to-duty (RTD), yet there are no validated standardized tasks with objective physiological measures. Impairments to the automatic nervous system (ANS) after mTBI may last beyond symptom resolution and impact readiness for duty. Assessment of ANS functioning (heart rate variability, HRV) could provide an objective measure of mTBI recovery.</p><p><strong>Materials and methods: </strong>Eighteen ADSM with mTBI (2 weeks or less post-injury) and 18 age-matched healthy controls (HC) performed a protocol of two brief exertional tasks that challenge exertional and autonomic impairments: a 6-minute metronome-paced step-task and a 2-minute self-paced push-up task with built in rest periods. Heart rate variability components Respiratory Sinus Arrhythmia (RSA; parasympathetic input) and heart period (HP; average inter-beat-intervals), symptoms levels, and rate of perceived exertion (RPE) were measured prior, during, and after each task. All study procedures were approved by The U.S. Army Regional Health Command-Atlantic (RHC-A) IRB, #2019-001.</p><p><strong>Results: </strong>Between group analyses of self-rated and HRV components demonstrated mTBI differences: higher RPE during recovery (B = 1.0, P < .01); increased symptoms under exertion (χ2(1,36) = 5.14, P < .03); lower RSA at Rest 1 (B = -1.0, P = .04) indicating longer recovery; higher RSA during push-ups (B = 1.22, P = .02; and higher Heart Period during both step (B = 75.34, P < .02) and push-up task (B = 84.43, P < .01)) indicating less vagal withdrawal compared to HCs. ADSM with mTBI were less likely to successfully complete both tasks (OR = 5.80, [1.79-18.82]).</p><p><strong>Conclusions: </strong>These brief exertional tasks may prove useful in primary care to identify symptomatic responses to exercise. Heart rate variability measurement may expose autonomic dysfunction that could influence readiness for full return to duty.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the Systemic Response to Flight After Polytrauma in a Murine Model.","authors":"Ellen R Becker, Gregory C Wetmore, Lindsey J Wattley, Adam D Price, Lisa England, Rebecca M Schuster, Timothy A Pritts, Michael D Goodman","doi":"10.1093/milmed/usaf446","DOIUrl":"https://doi.org/10.1093/milmed/usaf446","url":null,"abstract":"<p><strong>Introduction: </strong>Aeromedical evacuation continues to grow and push altitude boundaries as unmanned aerial vehicle feasibility is explored. The inherent hypobaric, hypoxic environment that comes with aeromedical evacuation is known to be deleterious in various injury models, but no studies have investigated the effects of post-injury flight after polytrauma. This study hypothesized that hypobaric hypoxia inherent to the aeromedical evacuation environment potentiates the proinflammatory milieu of murine polytrauma, worsens systemic and organ-level endotheliopathy, and modulates coagulability.</p><p><strong>Materials and methods: </strong>Mice underwent a polytrauma model consisting of midline laparotomy, rectus muscle crush, splenectomy, and hemorrhagic shock, followed by simulated flight for one hour at 12,000 feet. Cohorts included untouched, flight alone, polytrauma, and polytrauma with flight. Whole blood and lungs were collected. Serum inflammatory markers, serum endotheliopathy markers, lung immunohistochemistry, and coagulation profiles were analyzed.</p><p><strong>Results: </strong>Flight combined with polytrauma was found to elevate systemic proinflammatory cytokines, including IL-1β, MCP-1, MIP-1α, and TNFα, from control levels (P < .05). Notably, IL-1α was uniquely increased from polytrauma to polytrauma with flight (P < .05). The endotheliopathy biomarker, syndecan, was increased by polytrauma and polytrauma with flight compared to controls, but without a difference between polytrauma and polytrauma with flight. Lung histological markers of endothelial disruption and rotational thromboelastometry parameters were unchanged by flight after polytrauma.</p><p><strong>Conclusions: </strong>In this murine model of polytrauma and post-injury flight, early altitude exposure after polytrauma had an additive effect on the proinflammatory state, with the potential to differentiate flight exposure utilizing IL-1α. Early altitude exposure did not, however, exacerbate trauma-induced coagulopathy or endotheliopathy. Future studies should continue to address the physiologic basis of worsened clinical outcomes after early post-injury aeromedical evacuation.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}