Better therapy for combat injury

In modern warfare,therapy for combat injury is a critical issue to improve personnel survival and battle effectiveness.Be limited to the severe circumstance in the distant battlefield,quick and effective treatment cannot be supplied that leads infections,sepsis,multiple organ dysfunction syndrome(MODS)and high mortality.To get a better therapy for combat injury,we summarized several reports that associated with the mechanisms of sepsis and MODS,those published on MMR recently.Chaudry and colleagues reported gender difference in the outcomes of trauma,shock and sepsis.The advantageous outcome in female is due to their hormone milieu.Their accumulating reports indicated estrogen as a beneficial factor for multiple system and organs,including the central nervous system,the cardiopulmonary system,the liver,the kidneys,the immune system,and leads to better survival from sepsis.Thompson et al.reviewed the underlying mechanisms in trauma induced sepsis,which can be concluded as an imbalance of immune response triggered by damage-associated molecular patterns(DAMPs)and other immune modifying agents.They also emphasize immunomodulation as a better therapeutic strategy that might be a potential benefit in regulating the host immune response.Fan et al.have revealed a crucial mechanism underlying lung epithelial and macrophage crosstalk,which involves IL-25 as a mediator.After the injury,lung epithelial secreted IL-25 promotes TNF-αproduction in macrophage leading to acute lung injury(ALI).In addition to a mountain of cytokines,mitochondrial dysfunction in immune cell is another critical risk factor for immune dysfunction during sepsis.Both morphology and function alterations in mitochondria are closely associated with inadequate ATP production,insufficient metabolism process and overloaded ROS production,which lead harm to immune cells and other tissues by triggering oxidative stress.All the above reports discussed mechanisms of sepsis induction after trauma and provided evidence to improve better therapy strategies targeting diverse risk factors.

Wilderness medicine

BACKGROUND: Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest.METHODS: The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances(such as avalanches) while others have a broader scope(such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study.RESULTS: Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals.CONCLUSIONS: The future of wilderness medicine is unfolding on multiple fronts: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.

Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study

Background:Following combat-related,extensive soft tissue injury from gunshot wounds or blasts,prolonged duration from injury to full wound closure is associated with infection,increased morbidity and mortality,failure to mobilize,poor functional outcome and increased cost.The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds.Methods:This was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries(5 gunshot wounds,5 blasts)treated using the TopClosure^(■)Tension Relief System(TRS)with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy(ROINPT)via the Vcareα^(■)device.Results:Nine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction.Two patients had upper limb injury and the rest lower limb injury.With the aid of the TRS and/or ROINPT,immediate primary closure during reconstruction was achieved in 6 patients and delayed primary closure in three.Only one patient required a skin graft to close a small area of the wound after most of the wound had been closed by delayed primary closure.Wound closure was achieved within 0–37 days(median:12.5 days,interquartile range:2.75–19.75)from injury.Conclusions:The TRS is a novel device for effective,early skin stretching and secure wound closure through the application of stress relaxation and mechanical creep,achieving primary closure of large defects using a simplified surgical technique and reducing the need for closure using skin grafts and flaps and the use of tissue expanders.Delivering supplemental oxygen to the wound by ROINPT reverses the reduced oxygen levels inherent in conventional negative pressure-assisted wound therapy,mitigating anaerobic contamination and reducing infection.Irrigation may accelerate the evacuation of infectious material from the wound and provide a novel method for antibiotic administration.The combination of TRS and ROINPT devices allow for early primary closure with improved functionality of combat-related limb injuries.