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.

Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model

Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training,operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.Methods: A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed(using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.Results: In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/nonmodifiable, as well as extrinsic/intrinsic risk factors.Conclusions: This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.

System Approach to the Integration of Military and Civilian Productions in China

The author uses system analysis to provide system thinkings of the deepening reform of the management of defence science, technology and industry (DSTI) and investigate the system definition of DSTI, the system reform target, system operational mechanism, institutional structure, coordination and control functions and the orientation of conversion in China.

High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study

BACKGROUND Epidemiological studies have revealed an association between obstructive sleep apnea(OSA)and hypertension in the general population,while the association in military personnel was rarely investigated.AIM To examine the association between high risk for OSA and hypertension by phenotypes in military young adults.METHODS A total of 746 military personnel,aged 27.9 years,were included in the cardiorespiratory fitness and health in armed forces(CHIEF)-sleep study in Taiwan in 2020.Antihypertensive medications were not used by the subjects.High risk for OSA was assessed using the Berlin Questionnaire.Hypertension was defined using the 7th Report of the Joint National Committee on Prevention,Detection,Evaluation,and Treatment of High Blood Pressure(JNC 7)and the 2017 American College of Cardiology(ACC)/American Heart Association(AHA)guidelines.The cutoff levels of systolic and diastolic blood pressure(SBP and DBP)for the 2017 ACC/AHA-and JNC 7-based guidelines were 130/140 mmHg and 80/90 mmHg,respectively.Hypertension phenotypes included isolated systolic and diastolic hypertension(ISH,high SBP only and IDH,high DBP only)and combined hypertension(both high SBP and DBP).Multivariable logistic regression analysis with adjustment for demographics,lifestyle and metabolic biomarkers.RESULTS The prevalence of high risk for OSA,JNC 7-based hypertension and 2017 ACC/AHA-based hypertension were 8.0%,5.2%and 22.0%,respectively.Those with a high risk for OSA had a higher probability of JNC 7-based overall and combined hypertension(odds ratios(ORs))and 95%confidence intervals:2.82(1.07-7.42)and 7.54(1.10-51.54),although the probabilities of ISH and IDH were unaffected by a high risk for OSA(ORs:1.96 and 2.35,respectively,both P>0.05).In contrast,no associations for any hypertension phenotypes were found according to the 2017 ACC/AHA criteria.CONCLUSION A high risk for OSA was associated with severe hypertension and combined hypertension among Asian military young adults.

A Panorama of the Urological Diseases at the Former Military Teaching Hospital of Cotonou

Background: Urological care has been advancing quickly over the last ten years in Benin. In order to conveniently support that trend towards better urological care standards, decision-makers need sound data on urological diseases in the country. Objective: To determine the prevalence of urological diseases in the former Military Teaching Hospital of Cotonou. Patients and Method: We retrospectively collected the urological diseases that the institution had managed from January 2012 to December 2020. We used Excel© 2010 and SPSS© to analyze the collected data. Results: 4244 patients, i.e. 3717 males (87.58%) and 527 females (12.42%) were managed during the study period. The main diseases diagnosed were benign prostatic hyperplasia (32.61%, n = 1384), erectile dysfunction (10.44%, n = 443), chronic prostatitis (5.94%, n = 252), prostate cancer (4.03%, n = 171), and ejaculatory disorders (3.44%, n = 146). In patients ≤ 15 years, predominant diseases were peritoneal vaginal canal (15.9%, n = 43), circumcision (15.6%, n = 42), testicular dystopia (10.7%, n = 29), hydrocele (7.8%, n = 21), and hypospadias (5.6%, n = 15). Wilms tumor (1.9%, n = 5) was the first cancer, testicular (0.4%, n = 1) and para-testicular (0.4%, n = 1) tumors were the next. In patients > 15 and ≤40 years, the main diseases were infertility (14.1%, n = 189), chronic prostatitis (12.9%, n = 173), erectile dysfunction (10.1%, n = 135), ejaculatory disorders (6.2%, n = 83), genital infections (6.2%, n = 83) and urinary stone (4.9%, n = 66). The first cancer was kidney cancer (0.97%, n = 13) followed by bladder cancer (0.3%, n = 4) and testicular tumor (0.3%, n = 4). In patients >40 years, the most prevalent diseases were BPH (52.0%, n = 1370), erectile dysfunction (11.7%, n = 308), prostate cancer (6.5%, n = 171), inguinal hernia (5.1%, n = 134), and urinary stone (3.9%, n = 102). Prostate cancer is the first cancer;the next were bladder (0.95%, n = 25) and kidney (0.68%, n = 18) cancers. Conclusion: Benign prostatic hyperplasia and urological cancers (prostate, bladder and kidney cancers) were the main urological diseases at the former Military Teaching Hospital of Cotonou. Urological malformations and Wilms tumor were the main diseases in the children.

Discursive Construction of Chinese Military Image in the British Media

This study takes the image of China’s military as c onstructed in the British media’s military coverage of China as an object of study,and creates two reference corpora for comparative research.It is used to better analyse and compare the ideologies hidden in the British media’s coverage of China’s milita ry.From the analysis of the corpus,it is concluded that due to China’s rapid military and economic development,Western countries have developed a sense of crisis and have used media reports to instigate China’s foreign relations and mislead public think ing.

System dynamics simulation of the civil-military integrated innovation system of military enterprises

Civil-military inosculation of military enterprises benefits national defense industries by promoting the building of civil-military inosculation innovation system. To analyze the operation mechanism of the civil-military integrated innovation system of the military enterprises under the new situation, the system dynamics method is used to study the feedback relations among the factors and structure of the system and the Anylogic software is used to establish the simulation model . The simulation results indicate that： the degree of enthusiasm of private enterprises to participate in the defense industry, the degree of information sharing and the degree of cooperation between the mili- tary enterprises and universities and research institutions are extremely important in the civil-military integrated innovation system. According to the simulation results, some targeted suggestions are put forward to strengthen the innovational civil-military integrated system building of the military enter- prises.

MTTSNet:Military time-sensitive targets stealth network via real-time mask generation

The automatic stealth task of military time-sensitive targets plays a crucial role in maintaining national military security and mastering battlefield dynamics in military applications.We propose a novel Military Time-sensitive Targets Stealth Network via Real-time Mask Generation(MTTSNet).According to our knowledge,this is the first technology to automatically remove military targets in real-time from videos.The critical steps of MTTSNet are as follows:First,we designed a real-time mask generation network based on the encoder-decoder framework,combined with the domain expansion structure,to effectively extract mask images.Specifically,the ASPP structure in the encoder could achieve advanced semantic feature fusion.The decoder stacked high-dimensional information with low-dimensional information to obtain an effective mask layer.Subsequently,the domain expansion module guided the adaptive expansion of mask images.Second,a context adversarial generation network based on gated convolution was constructed to achieve background restoration of mask positions in the original image.In addition,our method worked in an end-to-end manner.A particular semantic segmentation dataset for military time-sensitive targets has been constructed,called the Military Time-sensitive Target Masking Dataset(MTMD).The MTMD dataset experiment successfully demonstrated that this method could create a mask that completely occludes the target and that the target could be hidden in real time using this mask.We demonstrated the concealment performance of our proposed method by comparing it to a number of well-known and highly optimized baselines.

Medical appraisal of Chinese military aircrew with abnormal results of coronary computed tomographic angiography

BACKGROUND Coronary artery diseases can cause myocardial ischemia and hypoxia,angina pectoris,myocardial infarction,arrhythmia,and even sudden death led to inflight incapacitation of aircrew.As the main cause of grounding due to illness,they severe threats to the health and fighting strength of military aircrew.Early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic.AIM To figure out the flight factors and clinical characteristics of military aircrew with abnormal results of coronary artery computed tomographic angiography(CTA),thereby rendering theoretical references for clinical aeromedical support of military flying personnel.METHODS The clinical data of 15 flying personnel who received physical examinations in a military medical center from December 2020 to June 2023 and were diagnosed with coronary artery diseases by coronary artery CTA were collected and retrospectively analyzed,and a descriptive statistical analysis was conducted on their onset age,aircraft type and clinical data.RESULTS The 15 military flying personnel diagnosed with coronary artery diseases by coronary artery CTA were composed of 9 pilots,1 navigator and 5 air combat service workers.Multi-vessel disease was detected in 9 flying personnel,among which 8(88.9%)were pilots.Flying personnel with multi-vessel disease had higher content of cholesterol,low-density lipoprotein cholesterol and apolipoprotein B than those with single-vessel disease.CONCLUSION Coronary artery diseases are the major heart disease for the grounding of flying personnel due to illness,which can lead to inflight incapacitation.Coronary artery CTA is conducive to early detection and early intervention treatment of such diseases in clinic.

Ultra reliability and massive connectivity provision in integrated internet of military things(IoMT)based on tactical datalink

One of the major challenges arising in internet of military things(IoMT)is accommodating massive connectivity while providing guaranteed quality of service(QoS)in terms of ultra-high reliability.In this regard,this paper presents a class of code-domain nonorthogonal multiple accesses(NOMAs)for uplink ultra reliable networking of massive IoMT based on tactical datalink such as Link-16 and joint tactical information distribution system(JTIDS).In the considered scenario,a satellite equipped with Nr antennas servers K devices including vehicles,drones,ships,sensors,handset radios,etc.Nonorthogonal coded modulation,a special form of multiple input multiple output(MIMO)-NOMA is proposed.The discussion starts with evaluating the output signal to interference-plus-noise(SINR)of receiver filter,leading to the unveiling of a closed-form expression for overloading systems as the number of users is significantly larger than the number of devices admitted such that massive connectivity is rendered.The expression allows for the development of simple yet successful interference suppression based on power allocation and phase shaping techniques that maximizes the sum rate since it is equivalent to fixed-point programming as can be proved.The proposed design is exemplified by nonlinear modulation schemes such as minimum shift keying(MSK)and Gaussian MSK(GMSK),two pivotal modulation formats in IoMT standards such as Link-16 and JITDS.Numerical results show that near capacity performance is offered.Fortunately,the performance is obtained using simple forward error corrections(FECs)of higher coding rate than existing schemes do,while the transmit power is reduced by 6 dB.The proposed design finds wide applications not only in IoMT but also in deep space communications,where ultra reliability and massive connectivity is a keen concern.

U.S.'Geopolitical Storms Take Toll on the Home Front

The United States is in the eye of two major geopolitical storms,both of which are incredibly expensive.On October 16,U.S.President Joe Biden approved$425 million in military aid to Ukraine amid Washington's ongoing proxy conflict with Russia.This is in addition to the over$61 billion in military aid provided to Ukraine since the beginning of the conflict in February 2022.In West Asia,U.S.military support for Israel as it wages ever expanding wars from Gaza to Lebanon hasamounted toat least$18 billion since October 2023.

An Exploration of the British Army Female Nursing Service during World War I

After the outbreak of World War I,the British War Office decided to dispatch female nursing personnel to the front lines due to the severe casualties among soldiers,the underdeveloped military medical services of the allied forces,and the maturity of the British Army female nursing service.Despite the harsh working conditions and the complexities of nurse-patient relationships under wartime restrictions,the female nursing staff also experienced moments of leisure that allowed them to relax and recuperate.The wartime British Army Female Nursing Service had a positive effect in reducing casualties and promoting the development of the official nurse registration movement.

Essence,Value and Development of the Military Judicial System

It was generally agreed that the military judicial system is a kind of military system rather than a justice system. It must effectively meet the practical needs of military operation,and of course,emphasize the promotion and maintenance of combat effectiveness.However,after the world war II,the military justice became more similar to the judicial system,more specifically,the military justice tended to be independent from the military power,and became more and more civilian and neutral. According to the Constitution of PRC,the military judicial system is a part of the national justice system. The military judicial system must first satisfy the requirement of the national justice system,and meet the needs of the reality of the military activities,realizing the coordinated unification of military system and national system.

Olfaction as a soldier——a review of the physiology and its present and future use in the military

Olfaction is one of our 5 main qualitative sensory abilities. In this review, we have examined the physiology of olfaction from the olfactory receptor to the brain. Through analyzing the physiology of olfaction, we have found that the biochemistry of olfactory nerve stimulation is unique from that of other similar pathways. Upon receiving large amounts of input from the olfactory nerve, the olfactory bulb, followed by several layers of centrifugal and centripetal processing in the brain, has to sort the information from the input as well as integrate it with other inputs from the brain to develop a coherent understanding of the input. We then examined the implications of olfaction in the military, the practical applications of electronic noses and problems associated with injury to olfaction that could affect compensation and combat worthiness of a soldier following injury. In the military, olfaction can allow the army to perform at its best through 4 main methods, namely ensuring olfaction is consistent with other dimensions of perception(ensuring optimal olfaction ability in all soldiers in combat), understanding the impact of different common combat environments on the sense of smell, utilizing odor as a defense mechanism and using olfactory aids when necessary. Electronic noses are olfactory aids that have a large potential in the military ranging from saving lives through the detection of explosives to potential methods for improving combustion efficiency. There are several problems associated with injury to olfaction that should be considered when deciding on compensation and combat worthiness of the soldier following an injury.

Knowledge mapping visualization analysis of the military health and medicine papers published in the Web of Science over the past 10 years

Background:Military medicine is a research field that seeks to solve the medical problems that occur in modern war conditions based on public medicine theory.Methods:We explore the main research topics of military health and medical research in the Web of Science?core collection(Wo SCC)from 2007 to 2016,and the goal of this work is to serve as a reference for orientation and development in military health and medicine.Based on Cite Space III,a reference co-citation analysis is performed for 7921 papers published in the Wo SCC from 2007 to 2016.In addition,a cluster analysis of research topics is performed with a comprehensive analysis of high-yield authors,outstanding research institutions and their cooperative networks.Results:Currently,the research topics in military health and medicine mainly focus on the following seven aspects:mental health diagnoses and interventions,an army study to assess risk and resilience in service members(STARRS),large-scale military action,brain science,veterans,soldier parents and children of wartime,and wound infection.We also observed that the annual publication rate increased with time.Wessely S,Greenberg N,Fear NT,Smith TC,Smith B,Jones N,Ryan MAK,Boyko EJ,Hull L,and Rona RJ were the top 10 authors in military health and medicine research.The top 10 institutes were the Uniformed Services University of the Health Sciences,the United States Army,the United States Navy,Kings College London,Walter Reed National Military Medical Center,Boston University,Walter Reed Army Institute of Research,Walter Reed Army Medical Center,Naval Health Research Center,and the VA Boston Healthcare System.Conclusion:We are able to perform a comprehensive analysis of studies in military health and medicine research and summarize the current research climate and the developmental trends in the Wo SCC.However,further studies and collaborations are needed worldwide.Overall,our findings provide valuable information and new perspectives and shape future research directions for further research in the area of military health and medicine.

Adherence to acne treatment guidelines in the military environment-a descriptive,serial cross-sectional study

Background:Acne vulgaris,a common skin disease,affects up to 80% of the population.Moderate to severe acne requires treatment with a combination of topical and oral drugs such as antibiotics,hormones and retinoids.Retinoids have many contraindications and adverse effects requiring close monitoring.The study's objectives were to describe prescribing trends in acne medication over time in a military setting,and assess physician adherence to guidelines for acne treatment,including drug precautions,clinical monitoring,and treatment progression.Methods:We conducted a descriptive,serial cross-sectional study of acne drugs prescribed in the Israel Defense Forces(IDF) in the years 2002–2007,analyzing the classes of drugs prescribed and patient characteristics.In addition,the clinical quality of the medical encounter was assessed by examining physician adherence to IDF guidelines.Results:Between 2002 and 2007,64,281 patients were treated for acne.Treatment courses generally persisted for 1–2 months.Over 70% of female patients receiving oral retinoids were not concomitantly receiving oral contraceptives.Conclusions:This study provides a unique perspective of acne treatment in a military setting,overall displaying good adherence to general guidelines.The common prescription of oral retinoids to young females without concomitant contraception is alarming.

Paederia foetida- a promising ethno-medicinal tribal plant of northeastern India

The northeastern region of India constitutes one of the biodi- versity hotspots of the world. The ethnic groups inhabiting this region practice their distinctive traditional knowledge systems using biodiver- sity for food, shelter and healthcare. Among the less-studied plants, Paederia foetida has been used by various ethnic tribes as food and medicine. Many of its therapeutic properties relate to the gastrointestinal system and suggest its potential utility for gastrointestinal ailments. This is a review of the ethnobotanical uses, phytochemistry and therapeutic properties of P. foetida compiled from various reports. P. foetida is promising as a remedy for life-style related conditions, especially treat- ment of ulcers. Its utility highlights the need for proper evaluation of tribal plants as medicines and the species could be considered for devel- opment of new drugs.

Investigation of the effect of military stress on the prevalence of functional bowel disorders

AIM: To investigate the morbidity of functional bowel disorders (FBD) under military stress conditions in order to lay foundations for the prevention and treatment of this disease. METHODS: Four hundred and fifty-seven soldiers who were assigned to specified services and 471 soldiers who were assigned to routine services were enrolled using cluster sampling, with the latter as a control group. They were surveyed using the Rome Ⅲ FBD standard questionnaire. The FBD symptom question-naire included FBD-related symptoms, severity, dura- tion or attack time, and accompanying symptoms. RESULTS: The morbidity of the military stress group (14.6%) was significantly higher than in the control group (9.98%) ( 2 = 4.585, P < 0.05). The incidence of smoking, abdominal pain and acid regurgitation ( 2 = 4.761, P < 0.05) as well as the ZUNG anxiety/depression scores ( 2 = 7.982, P < 0.01) were also sig- nificantly higher in the military stress group compared with the control group. ZUNG anxiety ( 2 = 11.523, P < 0.01) and depression ( 2 = 5.149, P < 0.05) scores were higher in the FBD group compared with the non-FBD group. The differences in the ZUNG self-rated anxiety and depression scales between the 2 groups were statistically significant ( 2 = 14.482, P < 0.01 and 2 = 6.176, P < 0.05). CONCLUSION: The morbidity of FBD was higher under military stress conditions.

Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans

Background:Large numbers of post-deployment U.S.veterans are diagnosed with post-traumatic stress disorder(PTSD)and/or traumatic brain injury(TBI),leading to an urgent need for effective interventions to reduce symptoms and increase veterans’coping.PTSD includes anxiety,flashbacks,and emotional numbing.The symptoms increase health care costs for stress-related illnesses and can make veterans’civilian life difficult.Methods:We used a randomized wait-list controlled design with repeated measures of U.S.military veterans to address our specific aim to test the efficacy of a 6-week therapeutic horseback riding(THR)program for decreasing PTSD symptoms and increasing coping self-efficacy,emotion regulation,social and emotional loneliness.Fiftyseven participants were recruited and 29 enrolled in the randomized trial.They were randomly assigned to either the horse riding group(n=15)or a wait-list control group(n=14).The wait-list control group experienced a 6-week waiting period,while the horse riding group began THR.The wait-list control group began riding after 6 weeks of participating in the control group.Demographic and health history information was obtained from all the participants.PTSD symptoms were measured using the standardized PTSD Checklist-Military Version(PCL-M).The PCL-M as well as other instruments including,The Coping Self Efficacy Scale(CSES),The Difficulties in Emotion Regulation Scale(DERS)and The Social and Emotional Loneliness Scale for Adults-short version(SELSA)were used to access different aspects of individual well-being and the PTSD symptoms.Results:Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR(P≤0.01)as well as a statistically and clinically significant decrease after 6 weeks of THR(P≤0.01).Logistic regression showed that participants had a 66.7%likelihood of having lower PTSD scores at 3 weeks and 87.5%likelihood at 6 weeks.Under the generalized linear model(GLM),our ANOVA findings for the coping self-efficacy,emotion regulation,and social and emotional loneliness did not reach statistical significance.The results for coping self-efficacy and emotion regulation trended in the predicted direction.Results for emotional loneliness were opposite the predicted direction.Logistic regression provided validation that outcome effects were caused by riding longer.Conclusion:The findings suggest that THR may be a clinically effective intervention for alleviating PTSD symptoms in military veterans.

Methods for improving thermal tolerance in military personnel prior to deployment

Acute exposure to heat, such as that experienced by people arriving into a hotter or more humid environment, can compromise physical and cognitive performance as well as health. In military contexts heat stress is exacerbated by the combination of protective clothing, carried loads, and unique activity profiles, making them susceptible to heat illnesses. As the operational environment is dynamic and unpredictable, strategies to minimize the effects of heat should be planned and conducted prior to deployment. This review explores how heat acclimation(HA) prior to deployment may attenuate the effects of heat by initiating physiological and behavioural adaptations to more efficiently and effectively protect thermal homeostasis, thereby improving performance and reducing heat illness risk. HA usually requires access to heat chamber facilities and takes weeks to conduct, which can often make it impractical and infeasible, especially if there are other training requirements and expectations. Recent research in athletic populations has produced protocols that are more feasible and accessible by reducing the time taken to induce adaptations, as well as exploring new methods such as passive HA. These protocols use shorter HA periods or minimise additional training requirements respectively, while still invoking key physiological adaptations, such as lowered core temperature, reduced heart rate and increased sweat rate at a given intensity. For deployments of special units at short notice(< 1 day) it might be optimal to use heat re-acclimation to maintain an elevated baseline of heat tolerance for long periods in anticipation of such an event. Methods practical for military groups are yet to be fully understood, therefore further investigation into the effectiveness of HA methods is required to establish the most effective and feasible approach to implement them within military groups.