bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soft Tissue Manipulation May Attenuate Inflammation, Modulate Pain, and Improve Gait in Conscious Rodents With Induced Low Back Pain
Authors: Loghmani M Terry , Tobin Carolyn , Quigley Colleen , Fennimore Alanna 
Published: January 2021

ABSTRACT

Introduction
Low back pain (LBP) is common in warfighters. Noninvasive interventions are necessary to expedite return-to-function. Soft tissue manipulation, for example, massage, is a method used to treat LBP. Instrument-assisted soft tissue manipulation (IASTM) uses a rigid device to mobilize the tissue. This study explored the effects of IASTM on pain, function, and biomarkers.

Methods
Sprague-Dawley rats (n = 44) were randomized to groups (n = 6/grp): (A) cage control; (B) 3 days (3d) postinjury (inj), untreated; (C) 3d inj, &lt; 30-minute post-IASTM treatment; (D) 3d inj, 2 hours (2h) post-IASTM; (E) 14 days (14d) inj, untreated; (F) 14d inj, &lt; 30-minute post-IASTM; and (G) 14d inj, 2h post-IASTM. Researchers induced unilateral LBP in Sprague-Dawley rats using complete Freund’s adjuvant injection. Conscious rodents received IASTM for 5 min/session once at 3 days or 3×/week × 2weeks (6× total) over 14 days. Biomarker plasma levels were determined in all groups, while behavioral outcomes were assessed in two groups, D and G, at three time points: before injury, pre-, and post-IASTM treatment. Circulating mesenchymal stem cell levels were assessed using flow cytometry and cytokine plasma levels assayed.

Results
The back pressure pain threshold (PPT) lowered bilaterally at 3 days postinjury (P &lt; .05), suggesting increased pain sensitivity. IASTM treatment lowered PPT more on the injured side (15.8%; P &lt; 0.05). At 14 days, back PPT remained lower but similar side to side. At 3 days, paw PPT increased 34.6% in the contralateral rear limb following treatment (P &lt; .01). Grip strength did not vary significantly. Gait coupling patterns improved significantly (P &lt; .05). Circulating mesenchymal stem cell levels altered significantly postinjury but not with treatment. Neuropeptide Y plasma levels increased significantly at 3 days, 2h post-IASTM (53.2%) (P &lt; .05). Interleukin-6 and tumor necrosis factor-alpha did not vary significantly. At 14 days, regulated on activation, normal T cell expressed and secreted decreased significantly &lt;30-minute post-IASTM (96.1%, P &lt; .002), while IL-10 trended upward at 2h (53.1%; P = .86).

Conclusions
LBP increased pain sensitivity and diminished function. IASTM treatment increased pain sensitization acutely in the back but significantly reduced pain sensitivity in the contralateral rear paw. Findings suggest IASTM may positively influence pain modulation and inflammation while improving gait patterns. Soft tissue manipulation may be beneficial as a conservative treatment option for LBP.
The Effect of Gelatin Molecular Weight on Tendon Lubrication Utilizing an Extrasynovialized Turkey Flexor Tendon Model
Authors: Forthofer, BS Michael J , Arnold, MS Katherine M , Reisdorf, BS Ramona L , Amadio, MD Peter C , Zhao, MD Chunfeng 
Published: January 2021

ABSTRACT

Introduction
Flexor tendon injuries are common hand injuries among the military population often resulting in functional impairment. Flexor tendon gliding friction has been linked to adhesion formation, especially with the use of extrasynovial grafts. Carbodiimide-derivatized hyaluronic acid with gelatin (cd-HA-gelatin) can reduce gliding friction of the tendon graft; however, the effects of gelatin molecular weight (MW) have not been studied. The turkey model has been shown to better match humans, but extrasynovial tendons are unavailable. The purpose of this study was to (1) manually roughen turkey flexor digitorum profundus (FDP) tendons to simulate extrasynovial tendons and (2) investigate the effects of gelatin MW on tendon friction.

Materials and Methods
The third digit of (n = 48) turkeys were dissected with the proximal pulley, and FDP tendon and the flexor superficialis tendon were preserved. Digits were randomly assigned into four groups: one saline control and three cd-HA-gelatin-treated groups of varying gelatin MW. Flexor digitorum profundus tendon friction was measured at its original condition, serving as a baseline. Tendons were roughened using a custom rig, and tendon friction was measured again. All four groups received treatment and gliding friction was measured every 100 cycles to a total of 1,000 cycles.

Results
Tendon friction significantly increased (P &lt; 0.05) after roughening. Friction in the saline control group increased steadily over repeated cycles, whereas friction of all gelatin-treated tendons decreased significantly compared with the saline control group (P &lt; 0.05), maintaining low friction to 1,000 cycles representing human tendons. There was no significant difference found between gelatin-treated groups.

Conclusions
We have developed a method to roughen synovial FDP tendons to create extrasynovial-like tendons for lubrication material evaluations. Cd-HA-gelatin effectively reduces tendon friction in this model. Our data suggest medium or low MW gelatin may provide a better reduction in friction compared with high MW gelatin.
Decision Support for Tactical Combat Casualty Care Using Machine Learning to Detect Shock
Authors: Nemeth Christopher , Amos-Binks Adam , Burris Christie , Keeney Natalie , Pinevich Yuliya , Pickering Brian W , Rule Gregory , Laufersweiler Dawn , Herasevich Vitaly , Sun Mei G 
Published: January 2021

ABSTRACT

Introduction
The emergence of more complex Prolonged Field Care in austere settings and the need to assist inexperienced providers’ ability to treat patients create an urgent need for effective tools to support care. We report on a project to develop a phone-/tablet-based decision support system for prehospital tactical combat casualty care that collects physiologic and other clinical data and uses machine learning to detect and differentiate shock manifestation.

Materials and Methods
Software interface development methods included literature review, rapid prototyping, and subject matter expert design requirements reviews. Machine learning algorithm methods included development of a model trained on publicly available Medical Information Mart for Intensive Care data, then on de-identified data from Mayo Clinic Intensive Care Unit.

Results
The project team interviewed 17 Army, Air Force, and Navy medical subject matter experts during design requirements review sessions. They had an average of 17 years of service in military medicine and an average of 4 deployments apiece and all had performed tactical combat casualty care on live patients during deployment. Comments provided requirements for shock identification and management in prehospital settings, including support for indication of shock probability and shock differentiation. The machine learning algorithm based on logistic regression performed best among other algorithms we tested and was able to predict shock onset 90 minutes before it occurred with better than 75% accuracy in the test dataset.

Conclusions
We expect the Trauma Triage, Treatment, and Training Decision Support system will augment a medic’s ability to make informed decisions based on salient patient data and to diagnose multiple types of shock through remotely trained, field deployed ML models.
Operationalizing the Deployment of Low-Titer O-Positive Whole Blood Within a Regional Trauma System
Authors: Schaefer Randall , Long Tasia , Wampler David , Summers Rena , Epley Eric , Waltman Elizabeth , Eastridge Brian , Jenkins Donald 
Published: January 2021

ABSTRACT

Introduction
The implementation of a low-titer O+ whole blood (LTOWB) resuscitation algorithm, particularly in the prehospital environment, has several inherent challenges, including cost, limited and inconsistent supply, and the logistics of cold-chain management. The Southwest Texas Regional Advisory Council has implemented the nation’s first multidisciplinary, multi-institutional regional LTOWB program. This research effort was to illustrate the successful deployment of LTOWB within a regional trauma system.

Materials and Methods
A deliberate systems approach to the deployment of LTOWB was used. Tenets of this program included the active management of blood donor sources and blood supply levels to minimize wastage as a result of expiration, maximize product utilization, the use of prehospital transfusion triggers, and efforts to decrease program costs prehospital agencies. A novel LTOWB rotation system was established using the concept of a “rotation site” and “rotation center.” Standardized transfusion criteria, a regional approved equipment list, a regional Prehospital Blood Product Transfusion Record, and a robust multilevel communication plan serves as the framework for the program. The San Antonio Whole Blood Consortium was developed to create a consensus driven forum to manage and guide the program.

Results
From January 2018 to October 2019, LTOWB has been placed at 18 helicopter emergency medical services (HEMS) bases, 12 ground emergency medical service (EMS) agencies, 1 level I trauma center, and 1 level IV trauma center. A total of 450 patients have received a prehospital LTOWB transfusion. Program wide, the wastage rate of LTOWB due to expiration is between 1% and 2%. No complications related to prehospital LTOWB administration have been identified.

Discussion
This work demonstrates a novel model for the development of a trauma system LTOWB program. The program’s implementation augments remote damage control resuscitation strategies and requires the integration and collaboration of a multidisciplinary stakeholder team to optimize efficiency, performance, and safety of the program.
Pars Plana Vitrectomy following Traumatic Ocular Injury and Initial Globe Repair: A Retrospective Analysis of Clinical Outcomes
Authors: Phillips Hunter H , Blegen IV Halward J , Anthony Christopher , Davies Brett W , Wedel Marissa L , Reed Donovan S 
Published: January 2021

ABSTRACT

Introduction
Penetrating and perforating ocular trauma are often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. A significant proportion of traumatic injuries are complex, often requiring vitreoretinal intervention to preserve vision. A retrospective analysis at a level 1 trauma center was performed to evaluate the time course, incidence, and outcomes following pars plana vitrectomy (PPV) after traumatic ocular injury and initial globe repair.

Materials and Methods
Eyes that underwent open globe repair following ocular trauma at Brooke Army Medical Center, between January 1, 2014 and December 30, 2016 were analyzed. Specific factors evaluated include mechanism of injury, defect size and complexity, ocular trauma score, zone of injury, associated orbital trauma, and time from injury to surgical intervention. A subset analysis was conducted specifically on eyes requiring subsequent PPV for vision preservation because of vitreoretinal disease. Surgical outcomes, time to secondary intervention, and complication rates were then assessed.

Results
In total, 70 eyes requiring open globe repair were examined, with 43 having undergone PPV. Average and median time to vitrectomy were 18.8 and 8 days, respectively. Eyes that underwent PPV were more likely to have an afferent papillary defect, vitreous hemorrhage, intraocular foreign body, and retinal detachment at the time of initial injury (although the latter two factors were not statistically significant), and were more likely to receive penetrating keratoplasty. Proliferative vitreoretinopathy occurred in 37.2% of eyes that underwent PPV, versus 3.7% of those that did not (P = 0.0013). Timing of PPV (i.e., before or after 14 days) had no statistically significant effect on the rate of PVR (Table I). Eyes that underwent PPV showed an improvement of visual acuity from average 2.5 logMAR following initial injury to 1.5 logMAR 6 months after PPV, equivalent to 18.7 Early Treatment Diabetic Retinopathy Study (ETDRS) letters gained, versus 37.7 ETDRS letters gained in eyes without PPV. Among PPV eyes, early repair (&lt;14 days) was associated with greater improvement in visual acuity.

Conclusion
Overall, patients requiring PPV following open globe repair generally had more severe injuries and worse 6-month postoperative visual acuity. Patients who underwent more expedited vitrectomy showed greater improvement in visual acuity as measured by ETDRS letters gained.
Shock Wave Physics as Related to Primary Non-Impact Blast-Induced Traumatic Brain Injury
Authors: Rutter Barbara , Song Hailong , DePalma Ralph G , Hubler Graham , Cui Jiankun , Gu Zezong , Johnson Catherine E 
Published: January 2021

ABSTRACT

Introduction
Blast overpressure exposure, an important cause of traumatic brain injury (TBI), may occur during combat or military training. TBI, most commonly mild TBI, is considered a signature injury of recent combat in Iraq and Afghanistan. Low intensity primary blast-induced TBI (bTBI), caused by exposure to an explosive shock wave, commonly leaves no obvious physical external signs. Numerous studies have been conducted to understand its biological effects; however, the role of shock wave energy as related to bTBI remains poorly understood. This report combines shock wave analysis with established biological effects on the mouse brain to provide insights into the effects of shock wave physics as related to low intensity bTBI outcomes from both open-air and shock tube environments.

Methods
Shock wave peak pressure, rise time, positive phase duration, impulse, shock velocity, and particle velocity were measured using the Missouri open-air blast model from 16 blast experiments totaling 122 mice to quantify physical shock wave properties. Open-air shock waves were generated by detonating 350-g 1-m suspended Composition C-4 charges with targets on 1-m elevated stands at 2.15, 3, 4, and 7 m from the source.

Results
All mice sustained brain injury with no observable head movement, because of mice experiencing lower dynamic pressures than calculated in shock tubes. Impulse, pressure loading over time, was found to be directly related to bTBI severity and is a primary shock physics variable that relates to bTBI.

Discussion
The physical blast properties including shock wave peak pressure, rise time, positive phase duration, impulse, shock velocity, and particle velocity were examined using the Missouri open-air blast model in mice with associated neurobehavioral deficits. The blast-exposed mice sustained ultrastructural abnormalities in mitochondria, myelinated axons, and synapses, implicating that primary low intensity blast leads to nanoscale brain damage by providing the link to its pathogenesis. The velocity of the shock wave reflected back from the target stand was calculated from high-speed video and compared with that of the incident shock wave velocity. Peak incident pressure measured from high sample rate sensors was found to be within 1% of the velocity recorded by the high-speed camera, concluding that using sensors in or close to an animal brain can provide useful information regarding shock velocity within the brain, leading to more advanced knowledge between shock wave physics and tissue damage that leads to bTBIs.
The Trifecta of Tele-Critical Care: Intrahospital, Operational, and Mass Casualty Applications
Authors: Ieronimakis Kristina M , Colombo Christopher J , Valovich Justin , Griffith Mark , Davis Konrad L , Pamplin Jeremy C 
Published: January 2021

ABSTRACTIntroductionTele-critical care (TCC) has improved outcomes in civilian hospitals and military treatment facilities (MTFs). Tele-critical care has the potential to concurrently support MTFs and operational environments and could increase capacity and capability during mass casualty events. TCC services distributed across multiple hub sites may flexibly adapt to rapid changes in patient volume and complexity to fully optimize resources. Given the highly variable census in MTF intensive care units (ICU), the proposed TCC solution offers system resiliency and redundancy for garrison, operational, and mass casualty needs, while also maximizing return on investment for the Defense Health Agency.Materials and MethodsThe investigators piloted simultaneous TCC support to the MTF during three field exercises: (1) TCC concurrently monitored the ICU during a remote mass casualty exercise: the TCC physician monitored a high-risk ICU patient while the nurse monitored 24 simulated field casualties; (2) TCC concurrently monitored the garrison ICU and a remote military medical field exercise: the physician provided tele-mentoring during prolonged field care for a simulated casualty, and the nurse provided hospital ICU TCC; (3) the TCC nurse simultaneously monitored the ICU while providing reach-back support to field hospital nurses training in a simulation scenario.ResultsTCC proved feasible during multiple exercises with concurrent tele-mentoring to different care environments including physician and nurse alternating operational and hospital support roles, and an ICU nurse managing both simultaneously. ICU staff noted enhanced quality and safety of bedside care. Field exercise participants indicated TCC expanded multipatient monitoring during mass casualties and enhanced novice caregiver procedural capability and scope of patient complexity.ConclusionsTele-critical care can extend critical care services to anywhere at any time in support of garrison medicine, operational medicine, and mass casualty settings. An interoperable, flexibly staffed, and rapidly expandable TCC network must be further developed given the potential for large casualty volumes to overwhelm a single TCC provider with multiple duties. Lessons learned from development of this capability should have applicability for managing military and civilian mass casualty events.
Evaluation of Fluorescent Light Energy for the Treatment of Acute Second-degree Burns
Authors: Mellergaard Maiken , Fauverghe Stéphane , Scarpa Carlotta , Pozner Vladimir Luca , Skov Søren , Hebert Lise , Nielsen Michael , Bassetto Franco , Téot Luc 
Published: January 2021

ABSTRACT

Introduction
The use of photobiomodulation has been proposed to improve wound healing for the last two decades. Recent development in photobiomodulation has led to the development of a novel biophotonic platform that utilizes fluorescent light energy (FLE) within the visible spectrum of light for healing of skin inflammation and wounds.

Materials and Methods
In this article, FLE was used in preliminary analysis on 18 case studies of acute second-degree burns and in a pilot study using an ex vivo human skin model. Efficacy of FLE on wound healing and tissue remodeling was evaluated by monitoring improvements in the treated tissues, assessing pain for the patients, and by performing human genome microarray analysis of FLE-treated human skin samples.

Results
Healing was reported for all 18 patients treated with FLE for acute second-degree burns without reported adverse effects or development of infections. Furthermore, preliminary ex vivo skin model data suggest that FLE impacts different cellular pathways including essential immune-modulatory mechanisms.

Conclusions
The results presented in this article are encouraging and suggest that FLE balances different stages of wound healing, which opens the door to initiating randomized controlled clinical trials for establishing the efficacy of FLE treatment in different phases of wound healing of second-degree burns.
Integrating User Voice in Hearing Care With Focus on Off-Duty Warfighter
Authors: Gupta Shayan , Xu Xuan , Liu Wilford , Zhang Jacqueline , Kelly Shawn 
Published: January 2021

ABSTRACT

Introduction
Noise-Induced Hearing Loss (NIHL) is a growing public health concern in the USA and globally because of the emergence of lifestyle preferences and environmental exposures to sound levels exceeding safe listening limits for extended periods of time. In the military, hearing and communication are important for survival and the Department of Defense’s Hearing Center of Excellence highlights the importance of protection from NIHL. Issuance of the World health organization safe audio listening standards along with existing U.S. federal and military standards provides a framework for developing an accessible tool for promoting safe listening.

Methods
An App is being proposed for an aggregated assessment of a user’s daily sound exposure, through personal audio system and ambient sources and providing tools for managing personal sound exposures. The key elements for development of App features were integration of user voice for functionalities, computations based on global standards, including military, for safe listening and alignment with regulatory standards for Apps.

Results
Features of the App are “Track” for audio and ambient exposures, “Compute” for real-time and cumulative exposures vs. safe listening standards, “Alert” for unsafe exposures using visual and haptic, “Inform” for personal exposures vs. safe dose, associated NIHL risk and education, “Choice” for alternatives that can be relatable to personal lifestyle, and “Share” for informing others as determined by the user. App safety is ensured by privacy and cybersecurity regulatory standards.

Conclusion
The overall goals of the App are to increase NIHL awareness and to empower users to improve personal listening behaviors that can potentially reduce the risk of NIHL.