Military Medicine最新文献

{"title":"Concurrent Surgical Care in an Austere Military Setting: A Preparation for Mass Casualty Events.","authors":"Lindsay Benham, Taylor Brocuglio, Dylan Maxwell, David Becerra","doi":"10.1093/milmed/usaf012","DOIUrl":"10.1093/milmed/usaf012","url":null,"abstract":"<p><strong>Background: </strong>The U.S. military utilizes small, forward deployed surgical teams to provide Role 2 surgical care in austere environments. These small teams are intended to be able to perform damage control resuscitation and surgery in the event of a mass casualty incident. Our team set out to demonstrate a proof of concept evolution by utilizing 2 operating rooms concurrently with a single certified registered nurse anesthetist and single surgeon to maximize the temporal efficiency of care by performing 4 elective surgical cases staggered in 2 rooms while deployed on an amphibious warship.</p><p><strong>Materials and methods: </strong>The surgical component of the Fleet Surgical Team is composed of a single general surgeon, a certified registered nurse anesthetist (acting as an independent practitioner), an operating room registered nurse, a critical care registered nurse, 5 surgical technicians, and 2 general duty corpsmen (consider these individuals roughly equivalent to a licensed practical nurse). Four elective surgical cases were selected to be performed on the USS Wasp while underway on the same date, divided between 2 adjacent operating suites to replicate the logistics of overlapping surgical care required during a mass casualty event.</p><p><strong>Results: </strong>The average surgical care overlap time during the 3 turnover periods was 33 min. The total time saved over the course of the 4 case day, when factoring in both surgical care overlap time and natural turnover time, was 2 h and 33 min.</p><p><strong>Conclusions: </strong>In the setting of multiple injured combat patients, this time saved is enough for an additional damage control trauma operation. When time is the critical factor in preventing both morbidity and mortality, the ability of a deployed surgical team to coordinate concurrent surgical care is of paramount importance. This report can act as a template for future austere surgical teams who encounter multiple simultaneous surgical casualties.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1806-e1810"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024086","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":"Optimizing Austere Surgical Team Efficiency: An Evaluation of Team Composition During U.S. Air Force Ground Surgical Team Training.","authors":"Robert J Edmonds, Didier N Hirwantwari, Dallas G Hansen","doi":"10.1093/milmed/usaf062","DOIUrl":"10.1093/milmed/usaf062","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal size of an austere surgical team needed to perform a damage control surgery has not been established, leading to variability in team composition among the myriad of single surgeon surgical teams within the DoD. The Air Force's conventional Ground Surgical Team (GST) includes 6 members; a surgeon, emergency physician, anesthesia provider, nurse, scrub technician, and medical administrator. The purpose of this study was to establish an evidence base for team composition among single-surgeon surgical teams by evaluating whether the addition of a second nurse would lead to an increase in effectiveness during GST phase 1 course simulations.</p><p><strong>Materials and methods: </strong>During the 2nd week, GST phase 1 training course held at Wright Patterson Air Force Base, Ohio, GST students complete 4 high fidelity team-based simulations requiring surgical intervention. The time to first incision was chosen as the primary outcome because of its known impact on patient survival in the unsimulated environment. Secondary outcomes included first full set of vitals, first administration of blood products, and time to call for evacuation. After Institutional Review Board and command approval, baseline control time measurements were obtained during 24 simulations completed by the standard 6-person teams. Time measurements were then obtained during 24 simulations with 7-person teams which included an additional nurse.</p><p><strong>Results: </strong>Variation was identified in the ability of both 6-person and 7-person teams to complete the measured tasks during the simulation. The addition of a second nurse had no statistical impact on the time to task completion.</p><p><strong>Conclusions: </strong>The variability in \"time to first incision\" among teams during GST phase 1 course demonstrates that certain teams are more efficient in the management of their simulated patients. This study suggests that the addition of a second nurse on GST will not improve the team's efficiency; however, limitations in the study preclude any definitive conclusion. Further research is needed to identify other factors that may impact team efficiency, such as the addition of a member with a different skillset, improvement in nontechnical skills, or an increase in trauma clinical experience.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2149-e2152"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557278","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":"The Impact of Critical Speed and Lean Body Mass on Load Carriage Performance for Army Reserve Officers' Training Corps Cadets.","authors":"Nathan D Dicks, Sean J Mahoney, Allison M Barry, Bryan K Christensen, Robert W Pettitt, Kyle J Hackney","doi":"10.1093/milmed/usae568","DOIUrl":"10.1093/milmed/usae568","url":null,"abstract":"<p><strong>Introduction: </strong>Load carriage is an inherent part of tactical operations. Critical speed (CS) has been associated with technical and combat-specific performance measures (e.g., loaded running). The 3-min all-out exercise test provides estimates of CS and the maximal capacity to displace the body (D') at speeds above CS. The current study investigated the contributions of CS, D', lean body mass (LBM), thigh lean mass (TLM), and lower body isokinetic strength and endurance parameters related to load carriage time trials (LCTTs).</p><p><strong>Methods: </strong>Twenty-two Reserve Officers' Training Corps cadets (6 = females, age = 20.82 ± 1.59 years) underwent various assessments that included a running 3-minute all-out test to determine CS and D', isokinetic knee extension (KE) muscle strength and endurance, body composition assessed by dual-energy X-ray absorption, and two 21-kg LCTTs of 400 and 3,200 m, respectively. Pearson's product-moment correlations investigated relationships between selected predictor variables. Stepwise multiple linear regression analyses were used to determine the relationship between variables that predicted LCTT performance.</p><p><strong>Results: </strong>Significant correlations were as follows: LBM and CS (r = 0.651, P < .001), KE endurance work and CS (r = 0.645, P < .001), TLM and CS (r = 0.593, P < .05), and KE peak torque and CS (r = 0.529, P < .05). The stepwise regression analyses indicated that CS and LBM contributed significantly to predicting 3,200-m LCTT (F [2,19] = 81.85, R2 = 0.90, P < .001) with standardized β coefficients (-0.723 and -0.301, respectively). Thigh lean mass contributed significantly to predicting the 400-m LCTT (F [1,20] = 46.586, R2 = 0.70, P < .001) with a standardized β coefficient (-0.836).</p><p><strong>Conclusion: </strong>The results of this study highlight that CS and LBM were the best predictors of the 3,200-m LCTT, and TLM was the best predictor of the 400-m LCTT. The findings of this study support that CS and LBM, including TLM, are important in predicting load carriage task completion in the time trial tasks.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1799-e1805"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965846","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":"Prototyping Intelligent Software Solutions for Global Health Engagement.","authors":"Jonathan Sussman-Fort, Lauren Glenister, Damian Jankowski, Nick Petroff, Col Ramey L Wilson, Capt Joseph Cohn","doi":"10.1093/milmed/usaf164","DOIUrl":"10.1093/milmed/usaf164","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding the Global Health Engagement (GHE) landscape is the key to effective military planning and execution across tactical, operational, and strategic levels. Global Health Engagements are intended to both help partner nations achieve the capacity, capability, and interoperability necessary to provide care to their own and also delivering an appropriate standard of care to U.S. service members, when needed. As standards and capabilities vary globally, planning GHEs is increasingly data-driven, relying on sources focused on GHE information requirements as well as those focused on GHE-supportive information needs. Current challenges to the use of GHE data in planning and crisis management are its lack of availability, standardization, integration, and visualization. Solving these challenges requires improved data curation, analysis, and user interface design to properly optimize engagements and care delivery.</p><p><strong>Materials and methods: </strong>Our research focused on supporting the Center for Global Health Engagement's (CGHE) ability to effectively plan, execute, and track a range of these engagements across the tactical, operational, and strategic levels. We leveraged Machine Learning (ML) capabilities including Large Language Models (LLMs) to assist users in making sense of large and disparate datasets. Our solution focused on automating the ingestion of data from unstructured text (GHE surveys), establishing a unified and standardized data format, developing interactive analytic tools, and presenting the results through user-specific visualizations to support decision-making and risk-informed course of action recommendations.</p><p><strong>Results: </strong>To curate, analyze, and visualize GHE data, we developed a prototype ML algorithm that employs an LLM for global health tactical-level hospital data ingestion, curation aggregation, and analysis and displays results for patient distribution in response to a crisis scenario using a 3D geospatial mapping visualization tool. The resulting capability uses an advanced, adaptive User Interface to visualize outputs from the ML algorithm, including providing explanations in a human-readable format on how the algorithm arrived at these outputs.</p><p><strong>Conclusion: </strong>The results provide practical applications for proof of concept of AI assistance in supporting global health data processing and analysis, with applications extending to the biosurveillance, medical countermeasures, and medical logistics domains. This study has direct implications for understanding partner healthcare capabilities and integrating them into military healthcare plans to support military and medical decision-making for operational planning, crisis management and conflict healthcare delivery and the planning and execution of future health engagements.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1889-e1896"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016792","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":"Comparing Diagnostic Accuracy of ChatGPT to Clinical Diagnosis in General Surgery Consults: A Quantitative Analysis of Disease Diagnosis.","authors":"Heather Meier, Ryan McMahon, Brittany Hout, Joshua Randles, James Aden, Julie A Rizzo","doi":"10.1093/milmed/usaf168","DOIUrl":"10.1093/milmed/usaf168","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This study addressed the challenge of providing accurate and timely medical diagnostics in military health care settings with limited access to advanced diagnostic tools, such as those encountered in austere environments, remote locations, or during large-scale combat operations. The primary objective was to evaluate the utility of ChatGPT, an artificial intelligence (AI) language model, as a support tool for health care providers in clinical decision-making and early diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The research used an observational cross-sectional cohort design and exploratory predictive techniques. The methodology involved collecting and analyzing data from clinical scenarios based on common general surgery diagnoses-acute appendicitis, acute cholecystitis, and diverticulitis. These scenarios incorporated age, gender, symptoms, vital signs, physical exam findings, laboratory values, medical and surgical histories, and current medication regimens as data inputs. All collected data were entered into a table for each diagnosis. These tables were then used for scenario creation, with scenarios written to reflect typical patient presentations for each diagnosis. Finally, each scenario was entered into ChatGPT (version 3.5) individually, with ChatGPT then being asked to provide the leading diagnosis for the condition based on the provided information. The output from ChatGPT was then compared to the expected diagnosis to assess the accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A statistically significant difference between ChatGPT's diagnostic outcomes and clinical diagnoses for acute cholecystitis and diverticulitis was observed, with ChatGPT demonstrating inferior accuracy in controlled test scenarios. A secondary outcome analysis looked at the relationship between specific symptoms and diagnosis. The presence of these symptoms in incorrect diagnoses indicates that they may adversely impact ChatGPT's diagnostic decision-making, resulting in a higher likelihood of misdiagnosis. These results highlight AI's potential as a diagnostic support tool but underscore the importance of continued research to evaluate its performance in more complex and varied clinical scenarios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In summary, this study evaluated the diagnostic accuracy of ChatGPT in identifying three common surgical conditions (acute appendicitis, acute cholecystitis, and diverticulitis) using comprehensive patient data, including age, gender, medical history, medications, symptoms, vital signs, physical exam findings, and basic laboratory results. The hypothesis was that ChatGPT might display slightly lower accuracy rates than clinical diagnoses made by medical providers. The statistical analysis, which included Fisher's exact test, revealed a significant difference between ChatGPT's diagnostic outcomes and clinical diagnoses, particularly in acute cholecystitis and diverticulitis cases. Therefore, we ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1858-e1862"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032629","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":"Correction to: Identifying Suicide-Related Predictors Using Overseas Airborne Infantry Brigade Serious Incident Reports.","authors":"","doi":"10.1093/milmed/usae574","DOIUrl":"10.1093/milmed/usae574","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 9-10","pages":"e2236"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138044","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":"Investigation and Analysis of Available Chatbot Technologies to Integrate in Multi-Domain Operational, Delayed/Disconnected, Intermittently Connected, Low-Bandwidth Conditions.","authors":"Triana Rivera-Nichols, Scott Evans, Alexander McKenzie, Holly H Pavliscsak, Richard L Barnhill","doi":"10.1093/milmed/usaf359","DOIUrl":"https://doi.org/10.1093/milmed/usaf359","url":null,"abstract":"<p><strong>Introduction: </strong>Paper-based clinical protocols and treatments have been historically used by combat medics to treat injuries and optimize survival. There is a need to replace these historical methods with digital processes to modernize the battlespace. With advances in artificial intelligence/machine learning (AI/ML), Chatbot interactions hold the potential to provide critical capabilities for military providers in Multi-Domain Operations (MDO), performing when connectivity is diminished or denied. Chatbots are autonomous, can also refine point of injury treatment, protocols-based patient care procedures, medical history, and current data. The Telemedicine and Advanced Technology Research Center (TATRC) and Madigan Army Medical Center (MAMC) have partnered to explore the feasibility of prototype clinical decision support system (CDSS) Chatbot solutions that feature ML and AI to aid combat medics in clinical protocols and treatment.</p><p><strong>Materials and methods: </strong>The current analysis has 3 phases: Phase 1: Available commercial off the shelf (COTS) options were evaluated to determine which COTS technologies were capable of functioning under Delayed/Disconnected, Intermittently Connected, Low-Bandwidth (DIL) MDO conditions. Phase 2: CDSS Chatbot algorithms were trained by the Algorithm Directed 2020 US Army MEDCOM Algorithm-Directed Troop Medical Care (ADTMC) protocols and validated against historical anonymized patient data from previous projects. Phase 3: Chatbot prototype will be integrated with hands-free headset technologies that will be interconnected with the hardware and software solutions acquired in Phase 1. The final prototype will be tested in DIL conditions.</p><p><strong>Results: </strong>Based on the needs assessment conducted in Phase 1, the solutions that offered portable, rugged, and secure devices in DIL/MDO conditions were the Amazon Web Services (AWS) Development Kit (software), AWS Snowball (hardware), Amazon Echo 10 (hands free), and Microsoft HoloLens (hands free) technologies. At the time of this abstract, prototype hardware and software integration into the hands free input devices, Echo 10 and HoloLens, are ongoing.</p><p><strong>Conclusions: </strong>This effort includes development, systematic assessment, and leveraging existing CDSS clinical algorithms into Chatbot enhanced CDSS prototypes that specifically focus on utilizing hands free inputs to provide appropriate medical guidance for casualty treatment.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"829-836"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125087","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":"Mental Health Impact of COVID-19 on Military Healthcare Workers: Not All War Is Fought on the Battlefield.","authors":"Kimera Joseph, Anthony Marrama, Apryl Susi, Elizabet Hisle-Gorman, Paul Andreason, Cade M Nylund","doi":"10.1093/milmed/usaf187","DOIUrl":"https://doi.org/10.1093/milmed/usaf187","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic challenged healthcare personnel worldwide. This study investigated the mental health of active duty military healthcare workers (HCWs) during the COVID-19 pandemic.</p><p><strong>Materials and methods: </strong>We conducted a retrospective monthly cross-sectional analysis of active duty military enlisted and officer HCWs' mental health encounter data from January 2018 to February 2023. Encounters for anxiety disorders, depressive disorders, reactive stress disorders, and suicidal attempt/ideation (SI) and self-harm were evaluated. Trends and trend changes in monthly rates of these 4 outcomes were evaluated using Joinpoint analysis. Poisson regression models evaluated the effect of time on the rates of these outcomes stratified by enlisted or officer status.</p><p><strong>Results: </strong>A total of 171,862 (122,413 enlisted, 49,449 officers) HCWs were included. Mental health utilization by both enlisted and officer HCWs had an upward trend for anxiety disorders, depressive disorders, reactive stress disorders, and suicidal attempt/SI and self-harm during the COVID-19 pandemic. Over the full study period, both enlisted and officer HCWs had significantly higher rates of all 4 outcomes in the second and third years of the pandemic. Female gender and older age were associated with higher rates across all outcomes, with the exception of SI and self-harm where the rates were higher among younger individuals.</p><p><strong>Discussion: </strong>Military healthcare providers experienced a significantly increased mental health burden during and following the COVID-19 pandemic. Females and older personnel were particularly vulnerable. These findings emphasize the need for targeted interventions to support these critical personnel during and after crises, such as resiliency training, peer support, and readily accessible mental healthcare services.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"348-356"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125118","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":"Encapsulation of Fibrinogen With Calcium Carbonate for Hemorrhage Control.","authors":"Henry T Peng, Tristan Bonnici, Christian Kastrup, Andrew Beckett","doi":"10.1093/milmed/usaf297","DOIUrl":"https://doi.org/10.1093/milmed/usaf297","url":null,"abstract":"<p><strong>Introduction: </strong>Combat-related hemorrhage remains the leading cause of preventable death, accounting for over 60% of fatalities. Dressings containing thrombin-calcium carbonate (CaCO3) particles combined with protonated tranexamic acid have been shown to reduce blood loss and mortality in severe bleeding cases. The integration of fibrinogen further enhances hemostatic efficacy. This study explores the preparation of fibrinogen-encapsulated CaCO3 particles using three innovative methods and evaluates their hemostatic and self-propelling properties.</p><p><strong>Materials and methods: </strong>Fibrinogen-CaCO3 particles were synthesized via water-oil-water encapsulation, precipitation, and gas diffusion methods. For the encapsulation method, fibrinogen in 20 mM HEPES and 1 M carbonate solution was emulsified with oil, Tween 80, and Span 80, and then added to a calcium chloride (CaCl2) solution, and stirred at 400 rotations per minute (RPM) for 10 min. For the precipitation method, fibrinogen was dissolved in 10 mM HEPES and 0.33 M Na2CO3, then combined with 0.33 M CaCl2, and stirred at 200 RPM for 2 h. Alternately, Na2CO3 was replaced with NaHCO3 or (NH4)2CO3. The gas diffusion method involved dissolving fibrinogen in CaCl2 solution, which was exposed to CO2 and NH3 generated from (NH4)2CO3 for 24 h in a desiccator. To quantify fibrinogen distribution, fluorescein isothiocyanate labeling of fibrinogen was performed before particle preparation. Particles were collected, washed, lyophilized, and characterized using microscopy, rotational thromboelastometry, and video motion tracking.</p><p><strong>Results: </strong>The method and preparation conditions significantly influenced the properties of fibrinogen-CaCO3 particles. Both precipitation and encapsulation methods produced spherical micrometer-sized particles, while the gas diffusion method resulted in irregular shaped particles. Variations in carbonate sources affected particle yield and size. Fibrinogen inclusion led to larger particles in the encapsulation method. Fluorescent microscopy confirmed the successful encapsulation of fibrinogen in all methods, with precipitation particles showing the strongest hemostatic effect. All fibrinogen-containing particles exhibited self-propulsion capabilities, with encapsulation particles outperforming others in terms of response time and propulsion speed.</p><p><strong>Conclusions: </strong>This study demonstrates that multiple techniques can be used to effectively produce fibrinogen-encapsulated CaCO3 particles with hemostatic and self-propelling properties. Further optimization of the formulation is planned to enhance these properties for hemorrhage control.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"662-669"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125120","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":"Evaluating the Safety and Efficacy of Humacyte Acellular Tissue-Engineered Vessel in a Real-World Combat Setting: A Retrospective Observational Multicenter Study.","authors":"Shamik Parikh, Oleksandr Sokolov, Vasyl Shaprynskyi, Oleh Skupyy, Oleksandr Stanko, Serhii Yurets, Yuliya Yurkova, Maria Fadri, Laura Niklason","doi":"10.1093/milmed/usaf160","DOIUrl":"https://doi.org/10.1093/milmed/usaf160","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Peripheral vascular trauma occurs as 10% of trauma injuries in combat settings. Its treatment in a combat setting is associated with challenges such as increased risk of infection, increased time to treatment, and lack of availability of medical personnel to perform vascular surgery. Currently, the autologous great saphenous vein or synthetic vessels such as Dacron or Gore-Tex (Teflon) are used to treat peripheral vascular trauma. Unfortunately, these options may neither be available nor advisable because of injury to the native vasculature or the increased risk of infection. Thus, an unmet medical need exists for peripheral vascular trauma among wounded military personnel. An alternative for autologous vein or synthetic vessel grafts mechanically similar to native vasculature and with increased infection resistance compared to synthetic alternatives is needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This multicenter, retrospective, observational study examines the use of the acellular tissue-engineered vessel (ATEV) for the treatment of peripheral vascular trauma in a combat setting in Ukraine. The ATEV is an acellular engineered human artery, manufactured from human vascular cells and then decellularized, generating an off-the-shelf conduit that can be immediately available for treatment of arterial injuries. A 1-year Humanitarian effort spanning from June 2022 to May 2023 treated a total of 19 patients suffering extremity arterial injuries with the ATEV in Ukraine. Retrospective data were collected for efficacy and safety outcomes in 17 of these patients, of whom 14 suffered battlefield injuries including gunshots, blast, and shrapnel-related trauma. The primary objectives were to evaluate the safety and efficacy of the Humacyte ATEVs that were implanted for arterial replacement or reconstruction in patients sustaining vascular trauma, and to determine the 30-day rate of primary ATEV patency. The secondary objectives were to determine the rates of ATEV infection, amputation, mortality, and adverse events of special interest related to the ATEV, to assess ATEV durability, and to determine the 30-day limb salvage, infection free time, and patency of the human acellular vessel regardless of interventions. The hypothesis was that ATEVs would achieve similar patency, infection-free rate, limb salvage, and safety outcomes as current standards of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After up to 18 total months of data collection in 17 subjects, ATEVs patency was 87.1% (95% CI, 42.5-97.8) up to 18 months. The infection-free rate for the ATEV conduits was 100%. Limb salvage and survival rates were also 100% up to 18 months. Overall, ATEV grafts were well tolerated, with no instances of immunological rejection. In two subjects, the ATEV was abandoned: in one case because of thrombosis, and in the other because of damage to the ATEV caused by remaining shrapnel.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;ATEV functioned ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"190 Supplement_2","pages":"288-296"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125137","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}