Military medicine in China: Old topic, new concept

Military medicine is important in both war and peace. In China, military medicine plays a key role in supporting and maintaining health, in preventing injuries and diseases in military staff and in enhancing the military armed forces during war. Additionally, military medicine participates in actions such as emergency public health crises, natural disasters, emerging conflicts and anti-terrorist campaigns during peacetime. In this paper, we summary the current condition and achievements in military medicine in China and provide our perspective for its future.

Depression in military medicine cadets: a cross-sectional study

Background: Military medicine cadets undergo strenuous military training alongside demanding medical studies. This stressful and complex educational environment can lead to the emergence of depressive symptoms. We investigated the prevalence of depressive symptoms in a cohort of military medicine cadets.Methods: We conducted a descriptive questionnaire-based cross-sectional study among Greek military medicine cadets in the undergraduate program of the Hellenic Military School of Combat Support Officers. The Greek translation of the Zung self-rating depression scale questionnaire was used to screen for the presence of depressive symptoms. In addition, demographic, academic and dietary information was collected. The Shapiro-Wilk test of normality, Pearson correlation test, Chi-square test, t-test and Mann Whitney U test were employed for statistical analysis.Results: We enrolled 55 female and 91 male military medicine cadets with a mean age of 19.84 years(SD=0.99). The mean Zung crude score was 43.32(SD=4.55): 42.8(SD=4.43) for female cadets and 43.64(SD=4.6) for male cadets. Cadets were further subdivided into low and high risk groups for the presence of depressive symptoms. We identified 57(39%) cadets with a total Zung crude score of 45 or above: 21 females and 36 males. Statistical analysis did not reveal any significant differences between the two groups based on gender, year of training, academic performance, alcohol consumption, smoking status, vitamin supplementation, dietary habits or BMI.Conclusion: We report a high prevalence of depressive symptoms in a cohort of military medicine cadets that underscores the need for effective screening and appropriate and timely interventions. We did not identify any related risk factors. Military medicine cadets are exposed to a challenging military and medical training environment, and thus represent a group at risk for development of depression.

Military medical research on internal diseases in modern warfare:new concepts,demands,challenges,and opportunities

Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield.The military medical research on battlefield internal diseases focuses on the pathogenesis,clinical management,and prevention of internal diseases under military war conditions.In both wartime and peacetime,the soldiers suffer from more internal diseases than surgical wounds.With the introduction of high-tech weapons,including chemical,physical,and biological agents,a large number of special internal illnesses and casualties will appear in future wars.The battles often occur in special environments,such as high or low temperatures,plateau or polar areas,and micro-or hyper-gravity.The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare.Therefore,the military medical research on battlefield internal medicine should be based on contemporary military situations,focus on the purpose of treating battlefield internal diseases,and adhere to the actual needs of the troops in peacetime and wartime.We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine.This review highlights new concepts,demands,challenges,and opportunities for the further development of military medical research on battlefield internal medicine.

Pushing the frontiers of military medical excellence:updates,progress and future needs

Since its establishment in 2014,Military Medical Research has come a long way in becoming a premier journal for scientific articles from various different specialties,with a special emphasis on topics with military relevance.The field of military medicine may be obscure,and may not be readily encountered by the typical clinician on a day-today basis.This journal aims not only to pursue excellence in military research,but also to keep current with the latest advancements on general medical topics from each and every specialty.This editorial serves to recap and synthesize the existing progress,updates and future needs of military medical excellence,discussing foremostly the unique traits of literature published in this journal,and subsequently presenting the discourse regarding wartime and peacetime medicine,the role of the military in a public health emergency,as well as wound healing and organ regeneration.Special attention has been devoted to military topics to shed light on the effects of Chemical,Biological,Radiological and Explosive warfare,environmental medicine and military psychiatry,topics which rarely have a chance to be discussed elsewhere.The interconnectedness between military combat and soldier physical and mental well-being is intricate,and has been distorted by pandemics such as coronavirus disease 2019(COVID-19).This journal has come a long way since its first article was published,steadily contributing to the existing knowledge pool on general medical topics with a military slant.Only with continuous research and sharing,can we build upon the work of the scientific community,with hopes for the betterment of patient care.

Medicine as Profession： An Overlooked Approach to Medical Ethics

This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved using a theory of professional ethics （more or less） absent from medical ethics until now though common outside. Employing a physician--rather than an ordinary officer, some other kind of healer, or scientist--is to enter a sort of ＂Ulysses contract＂ requiring the physician＇s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing （more than is now common） on other fields of practical ethics.

Research progress on combat trauma treatment in cold regions

Cold regions are a special combat environment in which low temperatures have a great impact on human metabolism and other vital functions, including the nervous, motion, cardiovascular, circulatory, respiratory, and urinary systems; consequently, low temperatures often aggravate existing trauma, leading to high mortality rates if rapid and appropriate treatment is not provided. Hypothermia is an independent risk factor of fatality following combat trauma; therefore, proactive preventative measures are needed to reduce the rate of mortality. After summarizing the basic research on battlefield environments and progress in the prevention and treatment of trauma, this article concludes that current treatment and prevention measures for combat trauma in cold regions are inadequate. Future molecular biology studies are needed to elucidate the mechanisms and relevant cell factors underlying bodily injury caused by cold environment, a research goal will also allow further exploration of corresponding treatments.

Organization and implementation of mass medical rescue after an earthquake

Over the past century, over 40 earthquakes measuring ≥7 on the Richter scale have occurred worldwide; of those, 10 took place in China and killed 600,000 people(accounting for 53% of the total number of global deaths due to earthquakes). On May 12, 2008, an 8.0-magnitude earthquake occurred in Wenchuan, Sichuan Province. In this disaster, 69,000 people were killed, 18,000 people were reported missing, and 37,000 people were injured, including more than 10,000 who were seriously injured. Trauma was the most commonly observed type of injury, with fractures accounting for 74% of all injury cases. On April 14, 2010, a 7.1-magnitude earthquake occurred in Yushu, in Qinghai Province. In this disaster, 2,698 people were killed, 270 people were reported missing, and 11,000 people were injured, including more than 3,100 who were seriously injured. Fracture injury accounted for 58.4% of all injury cases. After each earthquake, the Chinese Army Medical Services responded promptly, according to the previously established guidelines, and sent out elite forces to the disaster areas, with the objectives of organizing, coordinating and participating in an efficient and evidence-based medical rescue effort. After the Wenchuan earthquake, 397 mobile medical service teams including 7,061 health workers were sent to the disaster areas. A total of 69,000 casualties were treated, and 22,000 surgeries were performed. After the Yushu earthquake, 25 mobile medical service teams involving 2,025 health workers were sent. They performed 1,635 surgeries and created an astounding outcome of "zero deaths" in the aftermath of the earthquake during their treatment of casualties in a high-altitude region. Within a week after each earthquake, the military teams rescued approximately 60% of the total number of rescued casualties and evacuated approximately 80% of the total number of evacuated sick or wounded victims, playing a critical role and making invaluable contributions to earthquake relief. The experience and lessons learned from the rescue efforts of the Chinese military after the two earthquakes have highlighted several key aspects in emergency medical rescue: 1) medical rescue theories must be updated; 2) military-civilian cooperation must be stressed; 3) professional rescue forces must be strengthened; 4) supporting facilities must be improved; and 5) international exchanges and cooperation must be deepened.

Mesenchymal stem cell therapy for acute radiation syndrome

Acute radiation syndrome affects military personnel and civilians following the uncontrolled dispersal of radiation,such as that caused by detonation of nuclear devices and inappropriate medical treatments.Therefore,there is a growing need for medical interventions that facilitate the improved recovery of victims and patients.One promising approach may be cell therapy,which,when appropriately implemented,may facilitate recovery from whole body injuries.This editorial highlights the current knowledge regarding the use of mesenchymal stem cells for the treatment of acute radiation syndrome,the benefits and limitations of which are under investigation.Establishing successful therapies for acute radiation syndrome may require using such a therapeutic approach in addition to conventional approaches.

Must pilots permanently quit flying career after treatment for colorectal cancer?-Medical waiver for Air Force pilots with colorectal cancer: Three case reports

BACKGROUND Colorectal cancer(CRC)could seriously threaten the physical and mental health of pilots.Shall they end their flying after treatment of CRC?With this study,we investigated the possibility of a gradual medical waiver for such pilots to fly aircrafts again after treatment of CRC.CASE SUMMARY We analyzed the medical waiver and clinical data of 3 pilots with CRC,who had accepted the treatment at the Department of General Surgery,Air Force Medical Center(formerly,Air Force General Hospital)between 2013 and 2018.All 3 cases underwent a series of comprehensive treatment courses,including radical resection of CRC,sequential radiotherapy,and chemotherapy.The follow-up results were satisfactory.After passing through the high-risk period of recurrence and metastasis of CRC,they all were given a medical waiver for flying again.Medical observation showed that their flying operations were safe.CONCLUSION The CRC treatment shall follow the guidelines for diagnosis and treatment and should simultaneously protect the combating capabilities of pilots as much as possible.It is safe for pilots with CRC,who are continuously monitored under medical observation after passing through the high-risk period of recurrence and metastasis,to undertake military flight missions again.

Recent developments in computer assisted rehabilitation environments

Computer Assisted Rehabilitation Environment(CAREN) is a system that integrates a training platform(motion base), a virtual environment, a sensor system(motion capture) and D-flow software. It is useful for both diagnostic and therapeutic use. The human gait pattern can be impaired due to disease, trauma or natural decline. Gait analysis is a useful tool to identify impaired gait patterns. Traditional gait analysis is a very time consuming process and therefore only used in exceptional cases. With new systems a quick and extensive analysis is possible and provides useful tools for therapeutic purposes. The range of systems will be described in this paper, highlighting both their diagnostic use and the therapeutic possibilities. Because wounded warriors often have an impaired gait due to amputations or other extremity trauma, these systems are very useful for military rehabilitative efforts. Additionally, the virtual reality environment creates a very challenging situation for the patient, enhancing their rehabilitation experience. For that reason several Armed Forces have these systems already in use. The most recent experiences will be discussed; including new developments both in the extension of the range of systems and the improvement and adaptation of the software. A new and promising development, the use of CAREN in a special application for patients with posttraumatic stress disorder(PTSD), will also be reviewed.

Evaluation of Google Glass^(■) with Camera Adaptor and GoPro^(■) as Teaching Tools for Endotracheal Intubation in the Austere Medical Environment

Objective: Endotracheal intubation (ETI) is a life-saving emergency procedure, but it is a complex skill that is difficult to teach. Recent studies have shown that video laryngoscopy is effective in teaching ETI to learners at various levels of medical expertise;however, it has proven to be costly and provides images of inconsistent quality. In this educational proof of concept feasibility convenience sample pilot study, we aim to explore and compare the effectiveness of using modified Google Glass? (GG) and GoPro? (GP) technologies to visualize and teach ETI to critical care physicians in the austere medical environment of a low-income country. We propose, based on our findings, that this inexpensive technology could teach lifesaving ETI to pre-hospital providers in the austere medical environment, medical students, rural emergency physicians, critical care physicians in low-income countries, far forward military medical providers, and other learners. Methods: A case series of twenty-five patients, five in the United States (US) at Memorial Hospital in South Bend, IN and twenty at Saint Luc’s Hospital in Port Au Prince, Haiti, is presented. These patients were collected from November 1st 2015 through February 1st of 2016. The anesthesiologist and the emergency physicians in the United States utilized GG to intubate five patients in the US prior to the twenty patients intubated during two separate trips to Haiti. On the two separate trips to Haiti, the GG was trialed and modified to obtain better exposure. These adaptations resulted in the final collection of twenty patients studied with the adapted GG system and GP. Physicians graded airway visualization based on LEMON and Cormack-Lehane scores. Previously published parameters for the assessment of failed intubation risk and passage of the cords were used as data points for analysis using a Likert-Scale analysis for each parameter. The data were analyzed by averages of Likert-Scale scoring with their respective standard deviations. Results: The results show that the GP is superior to GG for assessing the LEMON scoring system until visualization of the oropharynx, while the GG is markedly superior for calculation of Cormack-Lehane score (cord visualization) and passing of the endotracheal tube. Conclusion: A review of the twenty-five cases demonstrates that while GP allows for better visualization for the parameters that require a wider view of the patient, the modified GG allows for superior visualization in the parameters that require a more focused view of the cords. GG can serve as an effective educational tool in the ICU for physicians and other providers in the austere medical environment who require effective ETI training. In addition, we propose that these techniques can serve as an inexpensive yet effective means of teaching hands on endotracheal intubation skills to learners of varying levels of clinical experience.

China's growing contribution to military Chinese medicine(2005-2014):a ten-year literature survey

OBJECTIVE： In China, people have relied on traditional Chinese medicine （TCM） for thousands of years to keep healthy and treat diseases. TCM also plays an important role in military health services and now forms a new discipline called military Chinese medicine （MCM）. However, the type, quality and focus of research articles about MCM have not been reported. The present study was performed to analyze the growing trends of MCM and investigate China＇s contribution to military health services. METHODS： China＇s MCM publications were retrieved from the PubMed database, as well as China Nationa~ Knowledge Infrastructure, Wanfang Data and Chongqing VIP database from 2005 to 2014. RESULTS： The study found that the number of published articles increased markedly from 2005 to 2014 Basic research studies comprised a small percentage of the literature. Among these studies, military training injury and special military environmental medicine were the most common research subjects in MCM. Military hospitals were the main institutions generating MCM literature. CONCLUSION： The quality of MCM research is generally low, as indicated by the proportion of publications in core journals. Studies on MCM still lack high-quality publications and internationa cooperation.

Civilian casualties of Iranian cities by ballistic missile attacks during the Iraq-lran war （1980-1988）

Objective： To determine the nature and extent of Iranian casualties by ballistic missile attacks during the eight years of the Iraq-Iran war. Methods： The data collected about Iraqi missile strikes on Iranian cities included the following： date and time, number and type of missiles, cities targeted, and injuries and deaths resulting from impacts of missiles in civilian areas. The data were extracted from a database that was constructed by the army staff headquarters based on daily reports of Iranian army units during the war. Results： Over a period of eight years （1980-1988）, Iraqi army fired 533 ballistic missiles at Iranian territories. From those, 414 missiles （77.7%） landed on Iranian cities. The impacts of these missiles caused the deaths of 2 312 civilians and injured 11 625 others. Three types of ballistic missiles were used： FROG-7, Scud, and Al-Hussein （a modified version of the Scud missile）. Twenty-seven cities in Iran were struck by Iraqi ballistic missiles. The highest mortalities from ballistic missiles were in Dezful and Tehran. Iraqi missile attacks continued for 90 months （2 748 days）. Conclusion： Our results point to the necessity of investigating the psychological consequences of Iraqi ballistic missile attacks among survivors in 27 Iranian cities during the eight years of the Iraq-Iran war.

Injuries in the Greek epics of Homer

Trauma and the need of medical care exist since the beginning of human history. This research is aimed to identify and analyze trauma in antiquity. After a review of bibliography, the first reports of trauma （in Europe） were found in the Greek Epics of Homer. The analysis of these texts showed that injury could be caused to any part of the human body. The main cause of trauma was primarily participation in wars （178 cases）, and then participation in sports （6 cases） and other activities （6 cases）. This study identified a total of 190 injuries in both Homer epics. The more serious injuries, many of which proved fatal, were observed from participation in military activities.