Supervisory Algorithm for Autonomous Hemodynamic Management Systems

Future military conflicts will require new solutions to manage combat casualties. The use of automated medical systems can potentially address this need by streamlining and augmenting the delivery of medical care in both emergency and combat trauma environments. However, in many situations, these systems may need to operate in conjunction with other autonomous and semi-autonomous devices. Management of complex patients may require multiple automated systems operating simultaneously and potentially competing with each other. Supervisory controllers capable of harmonizing multiple closed-loop systems are thus essential before multiple automated medical systems can be deployed in managing complex medical situations. The objective for this study was to develop a Supervisory Algorithm for Casualty Management (SACM) that manages decisions and interplay between two automated systems designed for management of hemorrhage control and resuscitation: an automatic extremity tourniquet system and an adaptive resuscitation controller. SACM monitors the required physiological inputs for both systems and synchronizes each respective system as needed. We present a series of trauma experiments carried out in a physiologically relevant benchtop circulatory system in which SACM must recognize extremity or internal hemorrhage, activate the corresponding algorithm to apply a tourniquet, and then resuscitate back to the target pressure setpoint. SACM continues monitoring after the initial stabilization so that additional medical changes can be quickly identified and addressed, essential to extending automation algorithms past initial trauma resuscitation into extended monitoring. Overall, SACM is an important step in transitioning automated medical systems into emergency and combat trauma situations. Future work will address further interplay between these systems and integrate additional medical systems.

Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)

The article describes armed conflicts on the territory of Iraq and Afghanistan. Improvement of individual and collective protection equipment has reduced the number of cases of soft tissue wounds in the extremities. The main cause of mortality and wound complications is antibiotic-resistant microflora. Purulent complications lead to chronic treatment of the wound healing process and a long period of specialized treatment and rehabilitation, which entails difficulties in the socialization of wounded servicemen, as well as significant financial costs from the state. When providing medical care to wounded military personnel, it is negative pressure wound therapy. Phage therapy is a promising method for treating infectious complications.

Combat Lesion in Triceratops: Histological and Chemical Diagnosis

In the collective imagination derived from scientific and popular literature, Triceratops often faced each other in combat. Thus, from the second half of the twentieth century, these ceratopsids were described as pugnacious animals. This arises primarily from the interpretation of extracranial fenestrae in ceratopsids being the result of combat trauma. However, the diagnosis of the traumatic nature of these anatomical variants of their neck frill requires evidence of bone healing and remodelling by microscopy analysis. Here, we present the case of the Triceratops horridus known as Big John, which is one of the largest specimens discovered in the Hell Creek Formation (Upper Cretaceous; MT, USA). Its right squamosal bone shows an extrafenestra with irregular margins and signs of inflammation. Microscopy analysis revealed newly formed and healing bone, with histological signs typical of the bone remodelling phase. Chemical analysis revealed sulphur that was derived from glucosaminoglycans and sulphated glycoproteins of the preosseous osteoid substance present in the healing phases of a bone trauma. Histological and microanalytical analyses confirm that the squamosal fenestra of Big John is the result of a traumatic event, which might indeed have occurred during combat with another Triceratops.

1364. Microbiology of Sepsis in a Combat-Trauma Military Population

Background There are limited data on sepsis in combat casualties. We examined characteristics of sepsis, specific infections, and associated microbiology in a complex combat trauma population. Methods The Trauma Infectious Disease Outcomes Study collected infection-related data from military personnel wounded during deployment (2009-2014). Medevac patients transferred to participating US military hospitals with sepsis or septic shock based on the Sepsis-1 SIRS criteria were analyzed for associated potential sources and infection-associated clinical microbiology. Results Prevalence of sepsis was 24.7% (667 of 2699 patients) with 93 (14%) patients meeting septic shock criteria. There were 1013 sepsis/shock episodes (SSE) among 667 subjects. Infections attributed to SSE were identified in 996 (98.3%) of 1013 episodes, primarily being bloodstream infections (BSI) +/- other infections (29.5%), skin and soft tissue (SSTI)/osteomyelitis (35.3%), pneumonia (12.1%), and multiple concurrent infections (14.2%). At least 1 organism was identified in 96% of SSE and 53% were polymicrobial. Gram-positive organisms (GP) were identified in 54% of SSE: 16% with multiple GP, of monomicrobial infections 4.1% were S. aureus, 15.8% other staphylococci, and 13% Enterococcus spp. Gram-negative bacilli (GN) were identified from 74.5% of SSE: 34% with multiple GN, of monomicrobial infections 11% were Pseudomonas spp., 8% E. coli, 6% Enterobacter spp., and 6% Acinetobacter spp. Mycobacterial species were uncommon (0.9%). Yeast, mold, and anaerobes were identified from 19%, 22%, and 12.5% of SSE, respectively. Compared to sepsis, septic shock infections were more often polymicrobial (p< 0.001), and had more infections with ESKAPEE pathogens, only Mucor spp., and only Bacteroides (p< 0.05). More infections with only Pseudomonas spp. and only non-lugdunensis coagulase-negative Staphylococci were identified among sepsis patients (p< 0.05). Conclusion Sepsis rates, using the Sepsis-1 criteria are sensitive but lack specificity supporting reclassification using updated Sepsis-3 criteria. In a complex trauma population, sepsis is common with most frequent infections related to SSTI/osteomyelitis, as well as BSI and multiple concurrent infections with a diverse spectrum of microbiology. Disclosures Dana M. Blyth, MD, Nothing to disclose

Review and Critical Evaluation of Cognitive Behavioural Therapy for the Treatment of Post-Traumatic Stress Disorder

This systematic analysis seeks to describe the evidence regarding cognitive-behavioral therapy (CBT) for the treatment of post-traumatic stress disorder (PTSD) in the recent, published, professional literature. This systematic review addressed the question of the efficacy of and evidence for CBT for the treatment of PTSD. The review incorporates a comprehensive literature review, addresses the methodological quality of the papers, and synthesizes the results by themes. After evaluation of the published and professional literature, five themes; Result of CBT for PTSD, Alternatives to CBT for PTSD, CBT in practice, Treatment of children, and CBT in tandem with medication. 11 published studies including qualitative interviews, randomized control trials, and meta-analyses were examined. CBT proved to be instrumental in alleviating PTSD symptoms in men who have been exposed to combat trauma, women who have experienced violence, veterans who have gone through combat trauma and also have disorders due to addictions, and young adults and children who have experienced trauma. Studies have shown that CBT works quite well in the case of couples where one has been diagnosed with PTSD. CBT for PTSD can be delivered face-to-face or by using telepsychiatry. CBT tends to have a higher success rate when carried out while administering appropriate drugs. Also, carrying out CBT for PTSD can bring about stronger relationships and post-traumatic stress growth. Keywords: Cognitive Behavioral Therapy, Post-Traumatic Stress Disorder, Treatment.

Possible Association of Polymorphisms in Ubiquitin Specific Peptidase 46 Gene With Post-traumatic Stress Disorder

Introduction: Dynamic proteolysis, through the ubiquitin-proteasome system, has an important role in DNA transcription and cell cycle, and is considered to modulate cell stress response and synaptic plasticity. We investigated whether genetic variants in the ubiquitin carboxyl-terminal hydrolase 46 (USP46) would be associated with post-traumatic stress disorder (PTSD) in people with exposure to combat trauma using a case-control candidate gene association design.Methods: Korean male veterans exposed to the Vietnam War were grouped into those with (n = 128) and without (n = 128) PTSD. Seven tagging SNPs of USP46 were selected, and single-marker and haplotype-based association analyses were performed. All analyses were adjusted for sociodemographic factors and levels of combat exposure severity and alcohol problem.Results: One single-marker (rs2244291) showed nominal evidence of association with PTSD status and with the “re-experiencing” cluster, although the association was not significant after Bonferroni correction. No significant association with the other SNPs or the haplotypes was detected.Conclusion: The present finding suggests preliminarily that genetic vulnerability regarding the ubiquitin-proteasome system may be related to fear memory processes and the development of PTSD symptoms after trauma exposure. Further studies with a larger sample size will be needed to examine the role of the ubiquitin-proteasome system including USP46 in PTSD.