Military Medicine最新文献

{"title":"Previously Treated or Remitted Posttraumatic Stress Disorder and Renewed Military Trauma Exposure: Evidence Gaps and a Provisional Fitness-for-Duty Framework.","authors":"Stefan Bigge","doi":"10.1093/milmed/usag431","DOIUrl":"https://doi.org/10.1093/milmed/usag431","url":null,"abstract":"<p><strong>Introduction: </strong>Military clinicians may be required to assess personnel with previously treated or remitted posttraumatic stress disorder (PTSD) for return to duty, deployment, weapons-related responsibilities, or other safety-sensitive assignments involving renewed trauma exposure. Direct evidence after verified remission and unrestricted military return is sparse. This review does not develop a new PTSD screening instrument or actuarial fitness score. Its aim is to synthesize the available evidence and translate it into a provisional, structured fitness-for-duty assessment and documentation framework.</p><p><strong>Materials and methods: </strong>A structured narrative review used targeted PubMed/MEDLINE searches from January 2000 through July 22, 2026. Search domains included prior or remitted PTSD, subsequent trauma and deployment, recurrence, treatment outcomes, comorbidity, sleep, moral injury, occupational functioning, screening, safety outcomes, and heart rate variability. Four reviewer-directed update searches yielded 220 unique records after deduplication. Military and veteran studies were prioritized. Evidence was classified as direct, near-direct, indirect, or contextual, and overlapping cohorts were treated as publication families rather than independent samples.</p><p><strong>Results: </strong>No cohort followed independently verified sustained PTSD remission through unrestricted military clearance or redeployment and prospectively measured recurrence, weapon incidents, duty failure, medical evacuation, or other safety outcomes. An active-duty case-control study documented 26 women who returned to full duty after PTSD-related limited duty, but its design did not permit estimation of a return-to-duty rate or later adverse outcomes. Two reports from the same 282-person active-duty residential-treatment cohort showed that only 32.6% achieved a clinically significant PCL-M reduction, residual symptoms remained frequent, and greater symptom improvement predicted longer military retention; treatment response was not remission. Among 523,626 active-duty Sailors and Marines, 83.3% of personnel diagnosed with PTSD had at least 1 examined comorbidity. Veteran data indicated that severe violence was associated with PTSD plus alcohol misuse rather than PTSD alone after adjustment. Deployment-related late-onset and chronic symptom trajectories were associated with suicidal ideation, supporting delayed reassessment. In a large VA cohort, study-defined symptomatic remission was associated with lower suicide mortality. Screening instruments and heart rate variability may support monitoring, but neither provides a validated military fitness threshold.</p><p><strong>Conclusions: </strong>Treated or remitted PTSD should be neither an automatic permanent contraindication nor a clinically neutral history. Fitness assessment should distinguish treatment response from sustained clinical and functional remission and separately evaluate re","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017384","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":"Feasibility of Immersive Virtual Reality for Assessing Mass-Casualty Triage Decision-Making in a NATO Civil-Military Emergency Management Exercise: A Cross-Sectional Study.","authors":"Lucia López Ferrándiz, Manuel Pardo Rios, Carmen Amalia Lopez Lopez, José Tortosa Alcázar, Marina Sánchez Gómez, Martin Lyubomirov Ivanov, Tatiana Cuartas-Alvarez, Rafael Castro-Delgado, Daniel Guillen Martinez, Ana Belén Ocampo Cervantes","doi":"10.1093/milmed/usag415","DOIUrl":"https://doi.org/10.1093/milmed/usag415","url":null,"abstract":"<p><strong>Background: </strong>Mass-casualty incident (MCI) triage is difficult to teach and assess under realistic operational conditions. Immersive virtual reality (VR) may provide a standardized and operationally relevant platform for evaluating triage decision-making and prioritization of immediate life-saving interventions during disaster preparedness exercises.</p><p><strong>Objective: </strong>To evaluate performance in MCI triage and prioritization of immediate life-saving interventions using an immersive VR scenario embedded in a NATO civil-military emergency management exercise, while also describing participants' perceptions of usefulness, ease of use, immersion, and physical comfort.</p><p><strong>Methods: </strong>This cross-sectional observational study was conducted during the NATO Emergency Management Exercise \"Bulgaria 2025\" in Montana, Bulgaria. Civilian and military first responders who completed the immersive scenario and post-experience questionnaire were included. The VR assessment, delivered through Meta Quest 3 headsets and haptic vests, comprised 14 triage items and 2 immediate life-saving intervention items. The reference standard for triage categorization was based on the Simple Triage and Rapid Treatment (START) algorithm. The primary outcome was item-level accuracy. Secondary outcomes included perceived usefulness, ease of use, immersion, physical comfort, and perceived contribution of haptic feedback.</p><p><strong>Results: </strong>A total of 102 valid post-simulation questionnaires were analyzed. Participants had a mean age of 34.3 years (SD 8.8), were predominantly male (98.0%), mainly military-affiliated (86.3%), and had a median of 10 years of professional experience. Triage performance was heterogeneous: accuracy exceeded 75% in several core items. Perceived usefulness and ease of use were high, with composite medians of 7.0 (IQR 6.0-7.0) and 7.0 (IQR 6.5-7.0), respectively. Presence/immersion was also high (median 6.25, IQR 5.5-7.0), and discomfort was low (median 1.0, IQR 1.0-2.0).</p><p><strong>Conclusions: </strong>In a NATO civil-military emergency management exercise, immersive VR was highly acceptable, usable, and well tolerated, while revealing substantial item-level variability in MCI triage decisions and immediate life-saving intervention choices. These findings suggest that immersive VR may offer a feasible and operationally relevant platform for standardized assessment of disaster triage performance and for identifying specific decision bottlenecks relevant to preparedness and interoperability.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008713","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":"Limited Associations Between Trunk Endurance and Landing Biomechanics in ROTC Cadets.","authors":"Julie P Burland, Zachary C Malone, Emma F Zuk, Lindsay J DiStefano, Laurie L Devaney, Cory M Edgar, Lauren N Sheldon, Shana Virtudes, Neal R Glaviano","doi":"10.1093/milmed/usag423","DOIUrl":"https://doi.org/10.1093/milmed/usag423","url":null,"abstract":"<p><strong>Introduction: </strong>Trunk activation is known to influence lower extremity kinematics and neuromuscular control during jump-landings; however, trunk endurance has not been explored in relation to potential movement errors associated with injury risk in Reserve Officers' Training Corps (ROTC) cadets. Therefore, we aim to evaluate the relationship between trunk endurance and biomechanics performance during the landing error scoring system (LESS) in ROTC cadets.</p><p><strong>Materials and methods: </strong>Cross-sectional study. 56 ROTC cadets (age: 20.22 years ± 1.69, height: 174.37 cm ± 8.46, weight: 73.15 kg ± 13.04) completed a trunk endurance and LESS scores during a jump-landing task. Trunk endurance was measured with a bilateral side plank hold for maximal time. The jump-landing task was evaluated using a markerless motion capture system (PhysiMax Technologies LTD) integrated with an Xbox Kinect camera (Microsoft, Redmond, WA). Total LESS score and errors related to frontal plane motion, specifically medial knee displacement and lateral trunk flexion at peak knee flexion, were scored via an automated scoring system. Two-tailed bivariate Pearson correlations evaluated the association between trunk endurance and LESS scores, with statistical significance set at P < .05. Correlations were defined as negligible (0.0-0.29), low correlation (0.30-0.49), moderate correlation (0.50-0.69), high correlation (0.7-0.89), and very high correlation (0.9-1.0).</p><p><strong>Results: </strong>The average plank time between right and left sides and LESS score for cadets was 88.72 ± 33.34 seconds and 5.36 ± 2.09 errors, respectively. There were non-significant negligible correlations between trunk endurance and total LESS scores (r = -.163, P = .231), total medial knee displacement errors (r = -.226 P = .094), total hip flexion displacement error (r =-.196, P = .147), lateral trunk flexion error (r = -.152, P = .263) and trunk flexion displacement (r = -0.086, P = .530).</p><p><strong>Conclusions: </strong>Our results show no clinical significance between trunk endurance and total LESS scores. However, there was a weak association between trunk endurance and right medial knee displacement. Future research should investigate how various dimensions of trunk performance, influence dynamic landing kinematics and LESS scores across both male and female populations.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008764","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":"Multidrug-Resistant Organisms in Combat-Related Injuries: Insights from Iraq, Afghanistan, Ukraine, and Implications for Large-Scale Combat Operations.","authors":"Rena Patierno, Elwood Conaway, Marcelo A F Riberio","doi":"10.1093/milmed/usag428","DOIUrl":"10.1093/milmed/usag428","url":null,"abstract":"<p><strong>Introduction: </strong>Armed conflict is a powerful driver of antimicrobial resistance, and combat-related infections caused by multidrug-resistant organisms (MDROs) have emerged as a defining challenge of modern military trauma care. Reports from Iraq, Afghanistan, and the ongoing conflict in Ukraine document a clear progression from multidrug-resistant to extensively drug-resistant (XDR) and pan-drug-resistant (PDR) pathogens. This review synthesizes current evidence on combat-related MDRO infections during large-scale combat operations (LSCO) and prolonged field care (PFC).</p><p><strong>Methods: </strong>A narrative literature review was conducted using MEDLINE/PubMed for English-language publications from January 2008 through April 2026, combining the terms war, armed conflict, combat injury, Iraq, Afghanistan, Ukraine, antimicrobial resistance, and multidrug-resistant organisms. Eligible sources included peer-reviewed original research, systematic and narrative reviews, and military clinical guidelines. Standard consensus definitions were used for MDR, XDR, and PDR.</p><p><strong>Results: </strong>Combat-related infections are predominantly polymicrobial and dominated by Gram-negative bacilli, particularly Acinetobacter baumannii, Pseudomonas aeruginosa, and carbapenem-resistant Enterobacterales. The Trauma Infectious Disease Outcomes Study (TIDOS) demonstrated MDR Gram-negative infection in approximately 27% of infected casualties from Iraq and Afghanistan. Surveillance from Ukraine reveals a qualitative escalation: meropenem resistance reaches 72% in A. baumannii and 83%-91% in K. pneumoniae, with co-production of NDM-1, OXA-48, and KPC-2 carbapenemases, frequent resistance to last-line agents (cefiderocol, ceftazidime-avibactam), and convergence of resistance and hypervirulence in international high-risk clones. Frontline wound cultures suggest that MDR acquisition is predominantly nosocomial, occurring along the evacuation chain rather than at the point of injury. Repatriation of foreign combatants colonized by XDR organisms now represents an unprecedented international dissemination risk.</p><p><strong>Conclusions: </strong>The MDRO burden in combat casualties is escalating in scale and severity, with direct implications for LSCO and PFC. Mitigation requires standardized antimicrobial protocols across Role 1 and Role 2 levels of care, centralized oversight by the Defense Health Agency, deployable rapid diagnostics, robust stewardship and infection-prevention programs, and resilient logistics-including drone-enabled medical resupply-to maintain antimicrobial effectiveness and operational readiness.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008679","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":"Efficacy of Digital HIV Risk Assessment and Uptake of HIV Pre-Exposure Prophylaxis Among U.S. Military Service Members: A Quality Improvement Project.","authors":"Dominica M Nucup, Autumn Roque","doi":"10.1093/milmed/usag426","DOIUrl":"https://doi.org/10.1093/milmed/usag426","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Human immunodeficiency virus (HIV) remains an important public health concern within the U.S. Armed Forces and a potential threat to force health protection and operational readiness. Within the Military Health System, a key problem is inconsistent engagement with HIV prevention services among at-risk service members despite mandated screening and universal access to pre-exposure prophylaxis (PrEP). Structural stigma, confidentiality concerns, and perceived career consequences may discourage participation in HIV prevention services, particularly when interventions rely on disclosure of sensitive behaviors during clinical encounters. Digital health strategies may provide confidential pathways for service members to assess personal risk and access prevention resources outside traditional clinical settings. This quality improvement initiative evaluated the feasibility and early system-level impact of implementing a confidential, QR-enabled mobile HIV risk self-assessment designed to increase engagement with preventive services, including HIV testing and PrEP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A pilot quality improvement initiative was implemented at a military branch health clinic serving approximately 8,500 active-duty personnel. A confidential, mobile-accessible HIV risk self-assessment was disseminated installation-wide through QR-coded flyers placed in high-traffic nonclinical locations and reinforced through leadership-supported email communication. Monthly QR scan counts were used as a measure of engagement with the intervention. Clinical outcomes included monthly HIV testing rates and PrEP prescribing rates per 1,000 active-duty personnel derived from aggregated electronic health record reports. A Poisson generalized linear regression model with a log population offset was used to evaluate contemporaneous and 1-month-lagged associations between QR scan exposure and clinical outcomes. The project met criteria for minimal-risk quality improvement and received institutional review board exemption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;QR scan engagement was concentrated during the initial implementation month, with 24 scans recorded and minimal activity observed in subsequent months. HIV testing rates during the primary analytic window ranged from approximately 40 to 69 tests per 1,000 active-duty personnel, reflecting readiness-driven screening requirements within the military health system. PrEP prescribing rates remained relatively stable throughout the observation period. Regression analyses did not demonstrate statistically significant associations between QR scan activity and same-month HIV testing or PrEP prescribing rates. However, lagged models demonstrated an association between QR scan exposure and subsequent-month HIV testing rates (incidence rate ratio [IRR], 1.015; 95% confidence interval [CI], 1.008-1.021; P &lt; .001). No statistically significant lagged association was observed for PrEP presc","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002142","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":"Surface Temperatures of Self-Warming Chemical Blankets Exceed Established Safety Thresholds: A Standardized Bench-Testing Study.","authors":"Nick Ralph, David Sturgess, Jed Duff, Fiona Wood, Philip Norris, Joseph Coory, Daevyd Rodda, Anselm Bräuer","doi":"10.1093/milmed/usag430","DOIUrl":"https://doi.org/10.1093/milmed/usag430","url":null,"abstract":"<p><strong>Introduction: </strong>Self-warming chemical blankets are widely deployed in military, prehospital, and hospital settings as a power-independent warming solution. Despite widespread use, no harmonized safety standard governing surface temperature limits for this device class is known to exist, and independent bench-testing data are sparse. This study aimed to characterize the thermal performance and safety profiles of commercially available self-warming chemical blankets and evaluate their suitability for use in military, prehospital, and perioperative contexts.</p><p><strong>Materials and methods: </strong>Four self-warming chemical blanket devices were subjected to standardized laboratory bench testing following the IEC 60601-2-35:2021 framework as an analogical reference standard. Twelve-channel K-type thermocouple arrays and infrared thermography recorded surface temperature distribution over time. Key outcomes included time to 40°C, maximum recorded surface temperature, surface temperature uniformity, and sustained high-temperature exposure duration.</p><p><strong>Results: </strong>The Hypothermia Prevention and Management Kit (HPMK) Full Body and HPMK-I Full Body Self-Heating Blankets reached maximum recorded temperatures of 69.1°C and 69.0°C, respectively, and the Ready-Heat Full Body Self-Heating Blanket reached 68.7°C, all substantially and persistently exceeding established burn thresholds for more than 12 hours. The Mölnlycke Barrier EasyWarm required over 81 minutes to reach peak temperature, did not achieve 40°C within clinically relevant timeframes, and also exceeded burn thresholds under prolonged contact. No device demonstrated simultaneous rapid attainment of therapeutic temperature and maintenance of safe surface temperatures.</p><p><strong>Conclusions: </strong>Commercially available self-warming chemical blankets exhibit a dual failure: they are too slow to provide therapeutic warming within the acute treatment window and generate surface temperatures consistent with serious burn risk under prolonged contact, particularly in patients with impaired peripheral circulation or reduced consciousness. The absence of a dedicated safety standard for this device class means that devices generating temperatures far above recognized burn thresholds are fully compliant with current regulatory requirements. The evidence base supporting clinical use of these devices is thin, and these findings are corroborated by burns reported to national device-safety databases. Urgent development of fit-for-purpose safety and performance standards is warranted, alongside review of the guideline endorsement and procurement that sustain the use of these devices.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990547","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":"Supplementation With Ketogenic Precursors Enhances Virtual Reality Shooting Performance During Sleep Restriction: A Randomized, Placebo-Controlled, Crossover Trial.","authors":"Alex Buga, Justen T Stoner, Teryn N Sapper, Chris D Crabtree, Drew D Decker, Bradley T Robinson, Madison L Kackley, Tyler McClure, Ashwini Chebbi, Holli Stalter, Landon Dawson, Arwen Whiteman, Mia Spencer, Lucas Lane, Scott M Hayes, Jesse Mindel, William J Kraemer, Jeff S Volek","doi":"10.1093/milmed/usag429","DOIUrl":"https://doi.org/10.1093/milmed/usag429","url":null,"abstract":"<p><strong>Introduction: </strong>Sleep restriction can impair shooting performance by 10%-40%, thereby diminishing operational effectiveness. Emerging evidence suggests that exogenous ketones may counteract the physical and cognitive declines associated with sleep loss; however, specific effects on shooting performance during sleep deprivation have not yet been evaluated.</p><p><strong>Materials and methods: </strong>Using a crossover, double-blind, placebo-controlled design, 32 healthy volunteers (16 women) underwent four consecutive nights of 50% sleep restriction in two sequences. Participants received a 25 g dose of either bis-octanoyl (R)-1,3-butanediol (BO-BD) or an isocaloric flavor-matched placebo before, twice daily during, and once after sleep restriction (9 doses per sequence). Capillary ketones were measured using a point-of-care device. Sleep duration/architecture were monitored using a wearable infrared skin monitor device. Accuracy, precision, decision-making, and reaction time were evaluated using a reliable virtual reality simulator. The reaction time task, Steel Plates, required participants to engage six targets from left to right as quickly as possible, with Hit Factor [(hits-misses)/time] serving as the primary metric.</p><p><strong>Results: </strong>Time in bed decreased from 7 hours 51 minutes at baseline to 4 hours 15 minutes during sleep restriction (-46%; P < .001). The BO-BD elevated capillary ketones (>1.0 mM) and augmented the time spent in deep sleep 13% relative to the placebo (P = .042). Independent of sleep and relative to placebo, BO-BD elicited an 8% greater Hit Factor (P < .001), 7% faster completion time (P < .001), 1% higher accuracy (P = .023), and 7% greater throughput (P < .001). Marksmanship and decision-making were overall preserved; however, loss of vertical rifle steadiness was associated with sleep loss (P = .052).</p><p><strong>Conclusion: </strong>A transient state of nutritional ketosis enhanced virtual reality shooting performance both before and after short-term sleep restriction. Acute and twice-daily BO-BD supplementation during sleep restriction may augment shooting speed and efficiency without affecting marksmanship or decision-making under sleep constraints.</p><p><strong>Clinical trial registration: </strong>Identifier: NCT05519644.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990486","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":"Anatomical Site-Specific Microbiological Divergence in Combat-Related Injuries During the Ukraine Conflict: A Comparative Analysis of Head, Torso, and Extremity Wounds.","authors":"Oleksandra Pryshchepa, Ewelina Sibińska, Viktoriia Avramenko, Oleksandr Bespalko, Yegor Babenko, Svitlana Yaremchuk, Michał Złoch, Polina Vakuliuk, Paweł Pomastowski","doi":"10.1093/milmed/usag420","DOIUrl":"https://doi.org/10.1093/milmed/usag420","url":null,"abstract":"<p><strong>Introduction: </strong>Combat-related infection research is overwhelmingly skewed toward extremity injuries because of the effectiveness of modern body armor. This creates a critical knowledge gap regarding the microbiological dynamics of non-limb anatomical sites, particularly in the context of intense warfare. This study evaluates the wound microflora of 51 Ukrainian soldiers during the second phase of the conflict with Russia, focusing on head and torso injuries. A key objective was to investigate how blast-induced acoustic barotrauma-including tympanic membrane perforation and mucosal damage-acts as a potential modifier of local microbiota composition in the ear, nose, and oropharyngeal regions.</p><p><strong>Materials and methods: </strong>Superficial swabs (58 total) were collected from torso, extremity, and ENT (ear, nose, oropharynx) wounds of 51 military patients undergoing prolonged hospitalization at the Kolomiychenko Institute of Otolaryngology in Kyiv. Microorganisms were isolated using selective media and identified via MALDI-TOF mass spectrometry. Identification was confirmed by 16S rRNA gene sequencing. The study received institutional approval from the NaUKMA Research Ethics Committee on June 9, 2025 (Protocol No. 8).</p><p><strong>Results: </strong>The analysis distinguished 209 isolates at the species level, covering 74 species and 36 genera. Gram-positive bacteria were the largest (71%) and most diverse group. Although extremity infections aligned with the established paradigm of Gram-negative dominance (63%), ENT wounds showed a dramatic Gram-positive prevalence (74%-97%), with Staphylococcus species representing 71% of aural isolates. Torso wounds exhibited an even distribution of Gram types (50/50), characterized by an unusually high frequency of Enterococcus (38.5%). ESKAPE pathogens accounted for 24% of all identified microorganisms, with S. aureus being most pronounced in the head area.</p><p><strong>Conclusions: </strong>These findings demonstrate that blast-induced barotrauma is not only a mechanical injury but a significant modifier of local microbiological environments. The study's strength lies in providing a comprehensive comparison of head, torso, and limb wounds, revealing that site-specific physiological conditions fundamentally alter colonizing microbiota. A primary challenge identified is the risk of diagnostic masking, where abundant commensal flora may obscure aggressive pathogens. Consequently, implementing site-specific diagnostic protocols and susceptibility testing is essential to optimize targeted antimicrobial therapy and improve the clinical prognosis for wounded soldiers.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920201","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":"Adverse Childhood Experiences and New-Onset of PTSD During Military Service.","authors":"Shlomi Abuhasira, Jacob Rotschield, Liya Kerem, Ariel Tenenbaum, Shir Lerner, Leah Shelef","doi":"10.1093/milmed/usag402","DOIUrl":"https://doi.org/10.1093/milmed/usag402","url":null,"abstract":"<p><strong>Introduction: </strong>Exposure to adverse childhood experiences (ACEs) has been increasingly recognized as a potential risk factor for later psychopathology; however, its role in the development of post-traumatic stress disorder (PTSD) during military service remains insufficiently characterized. This study aimed to examine the associations between ACE exposure and new-onset PTSD among Israeli Defense Force (IDF) recruits, and to identify an optimal ACE score threshold for PTSD risk stratification.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included 288,663 IDF recruits who underwent pre-enlistment mental health evaluations between 2009 and 2021. Data were obtained from military health records and ACE questionnaires administered before enlistment. PTSD diagnoses assigned by military psychiatrists were tracked longitudinally from enlistment to discharge. The associations between ACE exposure and new-onset PTSD were assessed using hierarchical logistic regression and Cox proportional hazards models. ROC analysis was conducted to identify the optimal ACE score threshold for PTSD prediction.</p><p><strong>Results: </strong>Of the cohort, 169 recruits (0.06%) received a PTSD diagnosis during military service, including 139 new-onset cases identified during follow-up. In multivariable analyses, combat service (OR = 2.998, P < .001) and low socioeconomic status (OR = 0.656, P = .007) were significant predictors of PTSD onset. Among individual ACE indicators, emotional neglect (OR = 2.268, P = .001) and sexual abuse (OR = 3.366, P < .001) independently predicted new-onset PTSD. ROC analysis identified an ACE score of ≥2 as the optimal threshold for PTSD prediction. Recruits with ≥2 ACEs demonstrated a nearly threefold increased risk of developing PTSD during service compared to those with one or no ACEs (HR = 2.799, P < .001).</p><p><strong>Conclusions: </strong>These findings highlight the significant role of early-life adversity in shaping PTSD risk within a military context. Specific ACE subtypes-particularly emotional neglect and sexual abuse-confer independent risk for PTSD onset during service, and an ACE score of ≥2 identifies a high-risk subgroup. Pre-enlistment ACE screening may offer a meaningful opportunity for targeted mental health surveillance and preventive intervention among recruits at elevated risk.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920241","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":"Radiation-Associated Brain Dysfunction in Military and Occupational Settings: Neuroimmune Mechanisms and Functional Outcomes.","authors":"Wataru Nagata, Colonel Kunio Takada","doi":"10.1093/milmed/usag425","DOIUrl":"https://doi.org/10.1093/milmed/usag425","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Radiation-associated brain dysfunction is relevant to military and occupational health because low-dose, chronic, documented, suspected, or perceived radiation exposure can raise questions about cognition, fatigue, vigilance, effortful task engagement, and work-relevant function. This narrative review focuses on biomedical and occupational-health studies relevant to brain-related functional outcomes after documented, suspected, or perceived radiation exposure. Evidence from radiotherapy, occupational radiation cohorts, radiological events, and whole-body or extracranial irradiation models suggests that structural injury alone does not capture all functional concerns after exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Targeted PubMed searches and reference-list screening primarily identified English-language biomedical and occupational-health literature published from 2020 through May 2026. Selected earlier studies were included when they provided foundational validation of representative assessment instruments or directly addressed irradiation models relevant to the review question. The synthesis prioritized radiation-induced brain injury, low-dose and low-dose-rate exposure, occupational and nuclear accident literature, neurovascular injury, glial responses, immunometabolism, gut-brain and systemic-to-brain signaling, and behavioral outcomes. This narrative review is not a systematic review or dose-reconstruction analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Recent evidence indicates a shift from structural injury alone toward mechanisms involving the neurovascular unit, blood-brain barrier, microglia, astrocytes, redox stress, systemic inflammatory signaling, and functional readouts. Occupational and emergency-response settings require distinction among documented dose, suspected exposure, perceived exposure, and post-incident distress. Whole-brain irradiation, whole-body irradiation, and extracranial irradiation are not interchangeable models because systemic immune, gastrointestinal, endocrine, and autonomic pathways can modify brain-related outcomes. Rodent behavioral assays provide domain-level probes of working memory, anxiety-like behavior, effort, vigilance, and sustained attention, but they do not directly model occupational performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Radiation brain-health research is most useful for military and occupational medicine when it pairs exposure documentation and context with brief assessment of cognition, fatigue and sleep, affect or distress, vigilance, and duty- or work-relevant function. Persistent symptoms, abnormal findings, high or uncertain dose, or impaired safety-sensitive performance should guide follow-up and referral. Neurovascular, glial, inflammatory, metabolic, and systemic mechanisms are best used to guide biomarker development, recovery assessment, and countermeasure timing rather than as current clinical screening tests. This framework applies ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911788","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}