Conjugation of Short-Chain Fatty Acids to Bicyclic-Amines for Analysis by Liquid Chromatography Tandem Mass Spectroscopy.

Conjugation of short-chain fatty acids (SDFAs) to amines containing ring structures allows for better measurement by liquid chromatography tandem mass spectroscopy (LC-MS/MS). However, collision-induced dissociation (CID) results in breaking the conjugate back to the original SCFA and amine. We therefore set out to find an amine that would remain on the SCFA after CID and create a unique daughter for selectivity of measurement.

Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial.

Importance: Fracture-related infection (FRI) is a serious complication following fracture fixation surgery. Current treatment of FRIs entails debridement and 6 weeks of intravenous (IV) antibiotics. Lab data and retrospective clinical studies support use of oral antibiotics, which are less expensive and may have fewer complications than IV antibiotics.

Carbohydrate and wound healing in critically ill burn patients: A retrospective cohort study.

Two randomized controlled trials conducted in acutely burned patients found clinical benefits with higher carbohydrate (60-65% of total energy), lower fat (12-15%) nutrition, to include faster wound healing, fewer wound infections, decreased hospital stay, and less pneumonia. The primary purpose of this study was to assess whether our change in practice to a higher proportion of carbohydrates (60%) with 25% of energy from protein, and 15% of energy from fat was associated with improved wound healing rates. Secondary outcomes evaluated included invasive fungal wound infections, ischemic bowel, sepsis, and mortality.

A Randomized, Blinded, Vehicle-Controlled Dose-Ranging Study to Evaluate and Characterize Remdesivir Efficacy Against Ebola Virus in Rhesus Macaques.

Ebola virus (EBOV) causes severe disease in humans, with mortality as high as 90%. The small-molecule antiviral drug remdesivir (RDV) has demonstrated a survival benefit in EBOV-exposed rhesus macaques. Here, we characterize the efficacy of multiple intravenous RDV dosing regimens on survival of rhesus macaques 42 days after intramuscular EBOV exposure.

Overview of Wearable Healthcare Devices for Clinical Decision Support in the Prehospital Setting.

Prehospital medical care is a major challenge for both civilian and military situations as resources are limited, yet critical triage and treatment decisions must be rapidly made. Prehospital medicine is further complicated during mass casualty situations or remote applications that require more extensive medical treatments to be monitored. It is anticipated on the future battlefield where air superiority will be contested that prolonged field care will extend to as much 72 h in a prehospital environment.

In Vivo Evaluation of Two Hemorrhagic Shock Resuscitation Controllers with Non-Invasive, Intermittent Sensors.

Hemorrhage is a leading cause of preventable death in military and civilian trauma medicine. Fluid resuscitation is the primary treatment option, which can be difficult to manage when multiple patients are involved. Traditional vital signs needed to drive resuscitation therapy being unavailable without invasive catheter placement is a challenge.

Evaluation of a Semi-Automated Ultrasound Guidance System for Central Vascular Access.

Hemorrhage remains a leading cause of death in both military and civilian trauma settings. Oftentimes, the control and treatment of hemorrhage requires central vascular access and well-trained medical personnel. Automated technology is being developed that can lower the skill threshold for life-saving interventions.

Development of a Stringent Ex Vivo-Burned Porcine Skin Wound Model to Screen Topical Antimicrobial Agents.

: Due to rising antibiotic-resistant microorganisms, there is a pressing need to screen approved drugs for repurposing and to develop new antibiotics for controlling infections. Current in vitro and ex vivo models have mostly been unsuccessful in establishing in vivo relevance. In this study, we developed a stringent ex vivo-burned porcine skin model with high in vivo relevance to screen topical antimicrobials.

Utilization and Outcomes of Epidural Anesthesia Versus Regional Anesthesia for Thoracic Surgery: An ACS-NSQIP Analysis.

Objectives: To determine the use of epidural anesthesia compared with regional anesthesia as an adjunct to general anesthesia in thoracic surgery over time, and compare length of stay, overall morbidity, serious morbidity, and mortality between epidural and regional anesthesia when utilized as adjuncts to general anesthesia in thoracic surgery.

Design: Retrospective data analysis from the American College of Surgeons National Surgical Quality Improvement Project data registry, years 2014 to 2022.

Setting: Over 800 U.

Observational Analysis of Point-of-Care Lactate Plus™ Meter in Preclinical Trauma Models.

Background/objectives: Blood lactate concentration is often used to assess systemic hypoperfusion, tissue hypoxia, and sepsis in trauma patients and serves as a prognostic indicator and marker of response to therapy. Point-of-care (POC) devices provide rapid lactate measurements with a single drop of blood. In this study, lactate values from whole blood, measured with two POC devices, Abbott i-STAT and the Nova Biomedical Lactate (LA) Plus™ meter, are compared.

Peritraumatic C-reactive protein levels predict pain outcomes following traumatic stress exposure in a sex-dependent manner.

Background: Chronic pain following traumatic stress exposure (TSE) is common. Increasing evidence suggests inflammatory/immune mechanisms are induced by TSE, play a key role in the recovery process versus development of post-TSE chronic pain, and are sex specific. In this study, we tested the hypothesis that the inflammatory marker C-reactive protein (CRP) is associated with chronic pain after TSE in a sex-specific manner.

Predicting blood loss volume in a canine model of hemorrhagic shock using arterial waveform machine learning analysis.

Objective: To determine if the compensatory reserve algorithm validated in humans can be applied to canines. Our secondary objective was to determine if a simpler waveform analysis could predict the percentage of blood loss volume.

Methods: 6 purpose-bred, anesthetized dogs underwent 5 rounds of controlled hemorrhage and resuscitation while continuously recording invasive arterial blood pressure waveforms in this prospective, experimental study.

Methodology used to develop the minimum common data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement.

Background: The objective was to summarize the methodology used to reach consensus for recommended minimum data elements that should be collected and reported when conducting injury surveillance research in military settings. This paper summarizes the methodology used to develop the international Minimum Data Elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement.

Methods: A Delphi methodology was employed to reach consensus for minimum reporting elements.

Immediate postinjury extracorporeal carbon dioxide removal reduces ventilator requirements and mitigates acute respiratory distress syndrome in swine.

Background: Awareness of ventilator-induced lung injury contributed to increased use of extracorporeal interventions, but not immediately after injury, before acute respiratory distress syndrome (ARDS) ensues. Our objective was to evaluate the role of venovenous extracorporeal carbon dioxide removal (ECCO2R) in management of mechanically ventilated swine with smoke inhalation injury and 40% body surface area burns.

Methods: Yorkshire swine (n = 29, 43.

Best Practices for Delivering Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma.

Importance: Neoadjuvant therapy (NT) is an increasingly used treatment strategy for patients with localized pancreatic ductal adenocarcinoma (PDAC). Little research has been conducted on cancer care delivery during NT, and the standards for optimal delivery of NT have not been defined.

Objective: To develop consensus best practices for delivering NT to patients with localized PDAC.

War at Sea: Burn Care Challenges-Past, Present and Future.

Throughout history, seafarers have been exposed to potential thermal injuries during naval warfare; however, injury prevention, including advances in personal protective equipment, has saved lives. Thankfully, burn injuries have decreased over time, which has resulted in a significant clinical skills gap. Ships with only Role 1 (no surgical capability) assets have worse outcomes after burn injury compared to those with Role 2 (surgical capability) assets.

Pharmacologic Considerations for Antimicrobials and Anticoagulants after Burn Injury.

Derangements in pharmacokinetics and pharmacodynamics (PK/PD) of burn patients are poorly understood and lacking consistent data. This leads to an absence of consensus regarding pharmacologic management of burn patients, complicating their care. In order to effectively manage burn critical illness, knowledge of pharmacologic parameters and their changes is necessary.

Burn Wound Care Strategies for the Battlefield and Austere Settings.

Burns are commonly encountered in the battlefield environment; however, the availability of burn expertise and specialized supplies is variable. Initial burn care should remain focused on cooling the burn, preventing hypothermia, basic wound cleansing, and evacuation. Key ongoing burn wound management principles include wound debridement, accurate burn size and depth estimation, wound care, ongoing wound evaluation, and treatment of suspected Gram-negative wound infection.

Combat and Operational Stress Control: Application in a Burn Center.

Occupational therapy has been integral to the holistic recovery of soldiers since its origin. The positive psychosocial and physiological effects of occupation-based interventions, fundamental to the profession, have long justified its relevance to the military. As such, occupational therapy has been written into US Army doctrine as an integral component of the Combat and Operational Stress Control (COSC) program.

Extracorporeal Organ Support for Burn-Injured Patients.

As mortality relating to severe acute burn injury improves, patients are surviving longer into the critical care phase, which is commonly complicated by multisystem organ failure. Extracorporeal organ support (ECOS) represents a set of potential therapeutic technologies for managing patients with organ-specific complications. This article provides a comprehensive review of the existing literature, focusing on the use of continuous kidney replacement therapy, extracorporeal membrane oxygenation, extracorporeal carbon dioxide removal, and extracorporeal blood purification.

Hypnosis in Burn Care: Efficacy, Applications, and Implications for Austere Settings.

Burn injuries are among the most traumatic events a person can endure, often causing significant psychological dysfunction and severe pain. Hypnosis shows promise as a complementary intervention to manage pain and reduce the psychological distress associated with burn injury and treatment. This paper reviews the literature regarding hypnosis and potential applications of hypnosis in the management of burns.

Rhabdomyolysis After Prolonged Tourniquet Application Is Associated with Reversible Acute Kidney Injury (AKI) in Rats.

Extremity trauma, including ischemia (e.g., prolonged tourniquet application or crush), is common among battlefield injuries.

Machine Learning Models for Tracking Blood Loss and Resuscitation in a Hemorrhagic Shock Swine Injury Model.

Hemorrhage leading to life-threatening shock is a common and critical problem in both civilian and military medicine. Due to complex physiological compensatory mechanisms, traditional vital signs may fail to detect patients' impending hemorrhagic shock in a timely manner when life-saving interventions are still viable. To address this shortcoming of traditional vital signs in detecting hemorrhagic shock, we have attempted to identify metrics that can predict blood loss.