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1.
Medicine (Baltimore) ; 99(11): e19292, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176054

RESUMEN

BACKGROUND: The aim of the study was to provide a theoretical basis for the early diagnosis and prediction of acute altitude sickness, to provide a better entry mode for healthy people from plain areas to plateau areas, and to preliminarily clarify the possible mechanism of this approach. METHODS: We measured endothelin-1 (ET-1), asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), nitric oxide (NO), and hypoxia-inducible factor 1 (HIF-1) levels in each sample and determined flow-mediated dilation (FMD) values using a portable OMRON color Doppler with a 7.0- to 12.0-MHz linear array probe. We used the Lewis Lake score to diagnose acute mountain sickness (AMS) and to stratify the disease severity. RESULTS: We found no cases of AMS at any of the studied elevation gradients. We found significant differences in FMD values between individuals when at 400 m above sea level and when at 2200, 3200, and 4200 m above sea level (P < .05) but found no significant differences among those at 2200, 3200, and 4200 m. Our variance analysis showed that serum ET-1, VEGF, ADMA, NO, and HIF-1 levels in individuals at ≥3000 m and those at subplateau and plain areas (<3000 m) significantly differed (P < .05). The level of these factors also significantly differed between individuals at elevation gradients of plateau areas (3260 m vs 4270 m) (P < .05). We found no significant differences in serum ET-1, VEGF, and ADMA levels between individuals at the plateau (2260 m) and plain (400 m) areas (P > .05). NO and HIF-1 levels were significantly different in serum samples from individuals between the plateau (2260 m) and plain (400 m) areas (P < .05). However, with increasing altitude, the NO level gradually increased, whereas ET-1, ADMA, VEGF, and HIF-1 levels showed a decreasing trend. With the increase of altitude, there is no correlation between the trend of FMD and hematologic-related factors such as VEGF, NO, and HIF-1. CONCLUSION: A healthy young male population ascending to a high-altitude area experiences a low incidence of AMS. Entering an acute plateau exposure environment from different altitude gradients may weaken the effect of acute highland exposure on vascular endothelial dysfunction in healthy individuals. Changes in serum ET-1, VEGF, ADMA, NO, and HIF-1 levels in healthy young men may be related to the body's self-regulation and protect healthy individuals from AMS. A short stay in a subplateau region may initiate an oxygen-free preconditioning process in healthy individuals, thereby protecting them from AMS. Noninvasive brachial artery endothelial function test instead of the detection of invasive hematologic-related factors for early diagnosis and prediction of the occurrence and severity of acute high-altitude disease is still lack of sufficient theoretical basis.


Asunto(s)
Mal de Altura/sangre , Altitud , Endotelina-1/sangre , Factor 1 Inducible por Hipoxia/sangre , Factor A de Crecimiento Endotelial Vascular/sangre , Enfermedad Aguda , Adulto , Mal de Altura/diagnóstico , Análisis de Varianza , Biomarcadores/sangre , China , Diagnóstico Precoz , Voluntarios Sanos , Humanos , Masculino , Personal Militar , Óxido Nítrico/sangre , Valores de Referencia , Sensibilidad y Especificidad , Adulto Joven
2.
Medicine (Baltimore) ; 99(12): e19535, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195957

RESUMEN

Hyperuricemia has been associated with metabolic syndrome, and the association with various cardiometabolic risk factors may be affected by sex.We made a cross-sectional examination in a military cohort of 6738 men and 766 women, aged 18 to 50 years of Taiwan in 2013 to 2014. Hyperuricemia were defined as serum uric acid levels ≥7.0 mg/dL for men and ≥5.7 mg/dL for women, respectively. Multivariable logistic regression analyses were used to determine the associations between hyperuricemia and various metabolic abnormalities.In the overall population, hyperuricemia was associated with high blood pressure (odds ratio [OR]: 1.59, and 95% confidence intervals: 1.42-1.77), low high-density lipoprotein (OR: 1.75, 1.56-1.97), high triglycerides (OR: 2.14, 1.90-2.42), high low-density lipoprotein (OR: 1.71, 1.51-1.93), high fasting plasma glucose (OR: 1.29, 1.13-1.48), and central obesity (OR: 2.85, 2.55-3.18) after adjusting for age and serum creatinine concentrations. However, the associations with atherogenic lipid profiles including high triglycerides and high low-density lipoprotein were merely significant in men but not in women. In addition, there was a tendency for a sex difference in the association of hyperuricemia and raised blood pressure ≥130/85 mm Hg, which was greater in women than that in men (OR: 2.92, 1.37-6.25 and 1.54, 1.37-1.72, respectively; P for interaction = .059).Our findings suggest that the association between hyperuricemia and various cardiometabolic abnormalities in young adults may differ by sex, possibly due to a regulation of sex hormones and uneven effects of uric acid at the same levels between sexes on lipid metabolisms and arterial stiffness.


Asunto(s)
Hiperuricemia/etiología , Síndrome Metabólico/complicaciones , Personal Militar/estadística & datos numéricos , Rigidez Vascular/fisiología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Hipertrigliceridemia/complicaciones , Hiperuricemia/epidemiología , Masculino , Síndrome Metabólico/epidemiología , Obesidad Abdominal/complicaciones , Factores de Riesgo , Caracteres Sexuales , Taiwán/epidemiología , Ácido Úrico/sangre , Adulto Joven
4.
Cancer Invest ; 38(3): 143-149, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32063067

RESUMEN

The USA Defense Threat Reduction Agency provided data in 2014 on the health status, including cancer, of the 4,843 sailors on the nuclear-powered United States Ship (USS) Ronald Reagan over the 2.55-year period from May 12, 2011 to Dec 31, 2013. Also provided were data on a matched control group of 65,269 US Navy personnel. Examination of the control population relative to the US national data gives a relative risk for all malignancies of RR = 9.2 (95% CI 8.48 < 9.2 < 9.96). The result suggests a significant cancer risk associated with serving on a nuclear-powered ship, one which is not predicted by the science underlying current radiation protection legislation.


Asunto(s)
Elementos Radiactivos/análisis , Personal Militar/estadística & datos numéricos , Neoplasias/epidemiología , Adolescente , Adulto , Relación Dosis-Respuesta en la Radiación , Elementos Radiactivos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/etiología , Programa de VERF , Estados Unidos/epidemiología , Adulto Joven
5.
Medicine (Baltimore) ; 99(3): e18746, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011456

RESUMEN

Converging evidence reveals the negative interpretation bias in anxiety. Given that anxiety is a severe psychological problem among Chinese military personnel, the present study examined whether high trait anxiety military personnel showed negative interpretation bias in real-world situations and whether their interpretations were influenced by self-relevance.The sample included 24 high trait anxiety (H-TA) and 22 low trait anxiety (L-TA) Chinese military servicemen. Participants completed 20 open-ended ambiguous scenarios by deciding how much they believed in the positive and negative ending of each sentence. The 20 scenarios were designed according to real life in military and half of them were self-relevant and the others were non-self-relevant.A 2(group) ×2(self-relevance) ANOVA of positive and negative endings revealed that compared to L-TA, H-TA believed more in negative continuations and less in positive continuations. Moderate correlations were found between samples' believes in positive and negative endings and their trait anxiety scores. Military personnel showed more positive interpretation biases in non-self-relevant scenarios than in self-relevant scenarios.These findings are the first to show interpretation bias in military situations, and interventional strategies to modify servicemen's interpretation bias could be designed according to military situations.


Asunto(s)
Trastornos de Ansiedad/psicología , Personal Militar/psicología , Adaptación Psicológica , Adolescente , Adulto , China , Humanos , Masculino , Pruebas Neuropsicológicas , Represión Psicológica
6.
Khirurgiia (Mosk) ; (2): 95-99, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32105263

RESUMEN

A 51-year-old severely burned woman had hospitalized at the Clinic of Thermal Injuries of the S.M. Kirov Military Medical Academy with a diagnosis: flame burn in a surface area of 40% (11%)/II-III b degrees of head, neck, trunk, limbs. Inhalation injury of moderate severity. The infusion drug of the combined action reamberin, which has a volemic and antihypoxic effect, had added to the complex antishock therapy. The presented clinical observation demonstrates the favorable course of burn shock: stopping of burn shock 28 hours after injury.


Asunto(s)
Quemaduras , Meglumina/análogos & derivados , Personal Militar , Choque , Succinatos , Quemaduras/complicaciones , Femenino , Fluidoterapia , Humanos , Meglumina/uso terapéutico , Persona de Mediana Edad , Choque/etiología , Choque/terapia , Succinatos/uso terapéutico
7.
Environ Pollut ; 259: 113872, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32069693

RESUMEN

The Arctic is subject to long-range atmospheric deposition of globally-distilled semi-volatile organic compounds (SVOCs) that bioaccumulate and biomagnify in lipid-rich food webs. In addition, locally contaminated sites may also contribute SVOCs to the arctic environment. Specifically, Alaska has hundreds of formerly used defense (FUD) sites, many of which are co-located with Alaska Native villages in remote parts of the state. The purpose of this study was to investigate the extent of SVOC contamination on Alaska's St. Lawrence Island through the analysis of sentinel fish, the ninespine stickleback (Pungitius pungitius), collected from Troutman Lake located within the watershed of an FUD site and adjacent to the Yupik community of Gambell. We measured the concentrations of legacy and emerging SVOCs in 303 fish samples (81 composites), including polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), organophosphate esters (OPEs) and their diester metabolites, and per- and poly-fluoroalkyl substances (PFAS). PBDEs and PCBs were the most abundant SVOC groups found in stickleback with ΣPBDE and ΣPCB median concentrations of 25.8 and 10.9 ng/g ww, respectively, followed by PFAS (median ΣPFAS 7.22 ng/g ww). ΣOPE and ΣOPE metabolite concentrations were lower with median concentrations of 4.97 and 1.18 ng/g ww, respectively. Chemical patterns and distributions based on correlations and comparison with SVOC concentrations in stickleback from other parts of the island suggest strong local sources of PCBs, PBDEs, and PFAS on St. Lawrence Island.


Asunto(s)
Monitoreo del Ambiente , Peces , Compuestos Orgánicos Volátiles , Contaminantes Químicos del Agua , Alaska , Animales , Regiones Árticas , Islas , Personal Militar , Compuestos Orgánicos Volátiles/análisis , Contaminantes Químicos del Agua/análisis
8.
Sci Total Environ ; 714: 136819, 2020 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-31986393

RESUMEN

The problems of determining the protective properties of barrier materials used for the production of body surface protection products of an isolative type are very actual. These garments are expected to have long-term resistance against permeation of toxic substances. The paper deals with the study of the effect of organic solvent vapours on the changes in protective properties of selected anti-gas protective garments commonly used by the North Atlantic Treaty Organization armed forces. Permeation measurements of selected gases with integral permeameter were performed to verify their barrier properties, surface changes after exposure to selected solvents by using a 3D optical profilometer, permeation measurements for vapours of these solvents with differential permeameter, and experimental simulating the possible influence of barrier properties of garments within permeation of air. It has been shown that in the case of gases, the permeability of the studied materials increases with decreasing kinetic diameter of the penetrant molecule used. In the case of acetonitrile and isooctane vapours, permeability increased with increasing vapour concentration due to interactions between polymeric materials and molecules of organic compounds. The permeation measurements of pure vapours and air/vapour mixtures indicate that the level of interactions between the molecules of the penetrant and the material of the protective garment is not strong enough to degrade the material of the garment in such a way as to allow a greater penetration of the pollutants through it. The results of permeation experiments for gases and organic vapours showed very good barrier properties of studied chemical isolated garments.


Asunto(s)
Personal Militar , Gases , Humanos , Permeabilidad , Ropa de Protección , Solventes
9.
Wien Klin Wochenschr ; 132(1-2): 47-49, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31912288

RESUMEN

Leishmaniasis is a severe vector-borne disease with two main clinical forms, visceral leishmaniasis and cutaneous leishmaniasis. Both forms of leishmaniasis are also endemic in Mediterranean countries including the Balkan region from where mainly visceral leishmaniasis is reported. Austrian soldiers returning from Kosovo were screened for anti-Leishmania antibodies to assess the risk of infection during operations. Anti-Leishmania antibodies were detected in more than 20% of the soldiers investigated, which indicates a considerable risk of infection during missions in this area and thus suggests the application of protective measures.


Asunto(s)
Leishmania , Leishmaniasis , Personal Militar , Animales , Austria , Humanos , Insectos Vectores , Kosovo , Leishmania/inmunología , Leishmaniasis/diagnóstico , Leishmaniasis/inmunología , Pruebas Serológicas
10.
J Consult Clin Psychol ; 88(2): 137-148, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31894995

RESUMEN

OBJECTIVE: This research evaluates changes in perceived military and civilian drinking norms as mechanisms of the effects of a motivational enhancement therapy (MET) intervention on changes in alcohol consumption among active-duty military personnel with a substance use disorder. We also evaluate the value of providing tolerance and family history risk-related personalized feedback by testing whether those receiving feedback indicating higher risk reduce their drinking more than those receiving feedback indicating lower risk or receiving no feedback. METHOD: Participants (N = 242; Mage = 28 years; 92% male; 59% Caucasian) completed a baseline questionnaire and were randomly assigned to a MET or educational control condition. Both conditions were single session and took place over the telephone. Outcomes were assessed 3 and 6 months later. The study was preregistered at ClinicalTrials.gov (NCT01128140). RESULTS: We found evidence that reductions in perceived norms for other military personnel, but not for civilians, mediated intervention efficacy on reductions in alcohol use. Further, the MET intervention was successful at reducing drinking among soldiers who reported higher levels of baseline tolerance and family history risk, but not succuessful at reducing drinking among those who reported low or medium levels of risk. CONCLUSIONS: Systematic evaluation of whether and how individual intervention components contribute to efficacy is a promising approach for refining and improving interventions. This research suggests that MET interventions may wish to target focal perceived norms and provides support for discussion of feedback indicating elevated risks due to tolerance and family history. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Alcoholismo/terapia , Retroalimentación Psicológica , Personal Militar/psicología , Entrevista Motivacional , Adulto , Alcoholismo/psicología , Femenino , Humanos , Masculino , Normas Sociales , Encuestas y Cuestionarios , Teléfono , Resultado del Tratamiento , Adulto Joven
11.
JAMA Netw Open ; 3(1): e1919935, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995212

RESUMEN

Importance: Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment. Objective: To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan. Design, Setting, and Participants: In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019. Main Outcomes and Measures: Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts. Results: A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged ≤29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI. Conclusions and Relevance: This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.


Asunto(s)
Personal Militar/psicología , Trastornos por Estrés Postraumático/psicología , Ideación Suicida , Suicidio/psicología , Adaptación Psicológica , Adulto , Campaña Afgana 2001- , Factores de Edad , Femenino , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Resiliencia Psicológica , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Trastornos por Estrés Postraumático/epidemiología , Suicidio/estadística & datos numéricos , Adulto Joven
12.
Int J Phytoremediation ; 22(3): 259-266, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31478391

RESUMEN

Permafrost thawing could increase soil contaminant mobilization in the environment. Our objective was to quantify metal accumulation capacities for plant species and functional groups common to Alaskan military training ranges where elevated soil metal concentrations were likely to occur. Plant species across multiple military training range sites were collected. Metal content in shoots and roots was compared to soil metal concentrations to calculate bioconcentration and translocation factors. On average, grasses accumulated greater concentrations of Cr, Cu, Ni, Pb, Sb, and Zn relative to forbs or shrubs, and bioconcentrated greater concentrations of Ni and Pb. Shrubs bioconcentrated greater concentrations of Sb. Translocation to shoots was greatest among the forbs. Three native plants were identified as candidate species for use in metal phytostabilization applications. Elymus macrourus, a grass, bioconcentrated substantial concentrations of Cu, Pb, and Zn in roots with low translocation to shoots. Elaeagnus commutata, a shrub, bioconcentrated the greatest amounts of Sb, Ni, and Cr, with a low translocation factor. Solidago decumbens bioconcentrated the greatest amount of Sb among the forbs and translocated the least amount of metals. A combination of forb, shrub, and grass will likely enhance phytostabilization of heavy metals in interior Alaska soils through increased functional group diversity.


Asunto(s)
Metales Pesados , Personal Militar , Contaminantes del Suelo , Alaska , Biodegradación Ambiental , Humanos , Suelo
13.
J Forensic Sci ; 65(1): 304-313, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31145812

RESUMEN

In 1949, the American Graves Registration Service Pacific Zone proposed the identification of 27 sets of remains (skulls/crania/mandibles) based on comparisons with written dental records. All were denied, and the remains were buried as unknowns. In 2003 and 2015, the remains were exhumed by the DPAA. Currently, 26 individuals previously recommended for identification have been positively identified. The DPAA Science Director's opinion corresponded with 24 of their recommendations, while DNA excluded three. Caution should be taken by the forensic scientist when building assemblages through skeletal and dental articulation. The forensic odontologist must always consider variations in restorative care/extraction patterns and the possibility of documentation errors when reviewing/interpreting historical and current day dental records used for AM/PM comparisons. The odontologist should base their opinion on the strength of the antemortem/postmortem comparison, number and type of concordances, and distinct dental care and extraction patterns.


Asunto(s)
Restos Mortales , Registros Odontológicos , Odontología Forense/métodos , Amalgama Dental , Prótesis Dental , Exhumación , Historia del Siglo XX , Humanos , Mandíbula/patología , Maxilar/patología , Personal Militar/historia , Fotograbar , Radiografía Dental , Diente/patología , Estados Unidos , Segunda Guerra Mundial
14.
Ann Vasc Surg ; 62: 51-56, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31201972

RESUMEN

BACKGROUND: Despite aggressive limb salvage attempts, military popliteal artery injuries are associated with high amputation rates. Combined arterial and venous injuries present a management dilemma for military surgeons in austere settings, and the impact of vein injury management strategy on limb outcomes is not clear. METHODS: Military casualties sustaining combined ipsilateral popliteal artery and vein injuries from 2003 to 2016 were identified from a military vascular injury database. Limbs were grouped based on whether venous ligation or repair was initially performed. The primary outcome was secondary amputation; the secondary outcomes included limb and vascular/graft complications. RESULTS: Fifty-six limbs were included; of which, 27 (48%) were managed with vein ligation and 29 (52%) with repair. Veins were repaired primarily in 13 (45%) cases with the remainder being treated with interposition grafts. Median injury severity score was higher in the ligation group (19 vs 15, P = 0.09), but vascular and concomitant limb injury characteristics were similar. Amputation rates did not differ by vein treatment (45% repair vs. 41% ligation, P = 0.76), and this held with injuries above and below the knee considered independently. Most (71%) amputations were performed <30 days from injury. Amputation was indicated more frequently for vascular repair failure in the ligated group (55% vs 15%, P = 0.04). Four graft infections were all in the repair group (P = 0.07 vs ligation). Arterial graft complications were more frequent with vein repair (45%) than ligation (30%), but this did not reach significance (P = 0.24). Only one deep vein thrombosis was diagnosed in each group (P = 0.96). CONCLUSIONS: Type of management of concomitant popliteal vein injury was not associated with early or late amputation in this series of military popliteal artery injuries. Vein injury management may have had implications for the development of arterial graft and limb complications, however. Surgical decision-making regarding popliteal vein treatment should balance short-term contingencies with long-term limb salvage issues.


Asunto(s)
Implantación de Prótesis Vascular , Personal Militar , Arteria Poplítea/cirugía , Vena Poplítea/cirugía , Procedimientos Quirúrgicos Reconstructivos , Lesiones del Sistema Vascular/cirugía , Adulto , Amputación , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Humanos , Ligadura , Recuperación del Miembro , Medicina Militar , Arteria Poplítea/lesiones , Vena Poplítea/lesiones , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
15.
Ann Vasc Surg ; 62: 98-103, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31344461

RESUMEN

BACKGROUND: The incidence of wartime upper-extremity vascular injury (UEVI) has been stable for the past century. The objective of this study is to provide a contemporary review of wartime UEVI, including epidemiologic characterization and description of early limb loss. METHODS: The Department of Defense Trauma Registry (DoDTR) was queried to identify US service members who sustained a battle-related UEVI in Afghanistan between January 2009 and December 2015. Anatomic distribution of injury, mechanism of injury (MOI), associated injuries, early management, and early limb loss were analyzed. RESULTS: Analysis identified 247 casualties who sustained 308 UEVIs. The most common injury was to the vessels distal to the brachial bifurcation (63.3%, n = 195), followed by the brachial vessels (27.3%, n = 84) and the axillary vessels (9.4%, n = 29). The predominant MOIs were penetrating explosive fragments (74.1%, n = 183) and gunshot wounds (25.9%, n = 64). Associated fractures were identified in 151 (61.1%) casualties and nerve injuries in 133 (53.8%). Angiography was performed in 91 (36.8%) casualties, and endovascular treatment was performed 10 (4%) times. Temporary vascular shunts were placed in 39 (15.8%) casualties. Data on surgical management were available for 171 injuries and included repair (48%, n = 82) and ligation (52%, n = 89). The early limb loss rate was 12.1% (n = 30). For all casualties sustaining early limb loss, the MOI was penetrating fragments from an explosion; the average injury severity score (ISS) was 32.3, and the mortality was 6.7% (n = 2). In those without amputation, the ISS and mortality were low at 20 and 4.6% (n = 10), respectively. Overall mortality was 4.9% (n = 12). CONCLUSIONS: The early limb loss rate was increased compared with initial descriptions from Operation Iraqi Freedom. Amputations are associated with a higher ISS. Improved data capture and fidelity, or differing MOIs, may account for this trend. Proficiency with open and endovascular therapy remains a critical focus for combat casualty care.


Asunto(s)
Traumatismos por Explosión/epidemiología , Procedimientos Endovasculares , Extremidad Superior/irrigación sanguínea , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/epidemiología , Heridas por Arma de Fuego/epidemiología , Campaña Afgana 2001- , Amputación , Traumatismos por Explosión/diagnóstico por imagen , Traumatismos por Explosión/mortalidad , Traumatismos por Explosión/terapia , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Humanos , Incidencia , Recuperación del Miembro , Medicina Militar , Personal Militar , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidad , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/mortalidad , Lesiones del Sistema Vascular/terapia , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/mortalidad , Heridas por Arma de Fuego/terapia
16.
Ann Vasc Surg ; 62: 268-274, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31449939

RESUMEN

BACKGROUND: The optimal surgical approach and treatment algorithm for thoracic outlet syndrome (TOS) remain controversial. We sought to examine the outcomes of patients treated at a military medical treatment facility (MTF) for TOS. METHODS: A retrospective review was performed on all patients who had a first rib resection (FRR) for TOS over a 9-year period at a single MTF. Patient demographics, perioperative details, and patient outcomes were examined. Active duty (AD) status and return to AD were reviewed. RESULTS: From 2008 to 2016, 33 FRRs were performed in 32 patients. Of these, 30 patients were on AD with a mean age of 27 years (range, 19-44). The 29 male and 4 female patients were treated for symptoms of venous (23), neurogenic (6), or arterial (4) TOS. The mean time from onset of symptoms was 11 months (range, 1 to 120). The FRR was performed via a transaxillary (13), supraclavicular (12), or paraclavicular (8) approach. Of 21 AD patients with venous TOS, 16 (76%) underwent preoperative thrombolysis. A postoperative venogram or ultrasound was performed in 20 patients, documenting vein patency in 18 (90%). Nine patients underwent subsequent venoplasty or stent placement. Most patients (15) were placed on anticoagulation for 1-6 months. Two AD patients had perioperative complications including a lymph leak and brachial plexus palsy. Twenty-four (89%) patients returned to AD status. One recruit never returned to AD after successful FRR, and two other patients did not return for medical reasons unrelated to the FRR. CONCLUSIONS: Despite a variety of surgical approaches and often delayed presentation, we identified a high percentage of postoperative vein patency and return to AD status in our population. The debate over surgical approach remains; however, a multimodal approach individualized to the patient's presentation and meticulous surgical technique led to successful outcomes in our healthy military population.


Asunto(s)
Descompresión Quirúrgica/métodos , Personal Militar , Osteotomía , Reinserción al Trabajo , Costillas/cirugía , Síndrome del Desfiladero Torácico/cirugía , Adulto , California , Descompresión Quirúrgica/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medicina Militar , Osteotomía/efectos adversos , Complicaciones Posoperatorias/fisiopatología , Recuperación de la Función , Estudios Retrospectivos , Síndrome del Desfiladero Torácico/diagnóstico por imagen , Síndrome del Desfiladero Torácico/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Adulto Joven
17.
Ann Vasc Surg ; 62: 119-127, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31476424

RESUMEN

BACKGROUND: By necessity, wartime arterial injuries undergo staged management. Initial procedures may occur at a forward surgical team (role 2), where temporary shunts can be placed before transfer to a larger field hospital (role 3) for definitive reconstruction. Our objective was to evaluate the impact of staging femoropopliteal injury care on limb outcomes. METHODS: A military vascular injury database was queried for Iraq/Afghanistan casualties with femoropopliteal arterial injuries undergoing attempted reconstruction (2004-2012). Cases were grouped by initial arterial management: shunt placed at role 2 (R2SHUNT), reconstruction at role 2 (R2RECON), and initial management at role 3 (R3MGT). The primary outcome was limb salvage; secondary outcomes were limb-specific complications. Descriptive and intergroup comparative statistics were performed with significance defined at P ≤ 0.05. RESULTS: Of 257 cases, all but 4 had definitive reconstruction before evacuation to Germany (median, 2 days): 46 R2SHUNT, 84 R2RECON, and 127 R3MGT; median Mangled Extremity Severity Score was 6 for all groups. R2SHUNT had median extremity Abbreviated Injury Scale--vascular of 4 (other groups, 3; P < 0.05) and was more likely to have concomitant venous injury and to undergo fasciotomy. Shunts were used for 5 ± 3 hr. About 24% of R2RECON repairs were revised at role 3. Limb salvage rate of 80% was similar between groups, and 62% of amputations performed within 48 hr of injury. Rates of limb and composite graft complications were similar between groups. Thrombosis was more common in R2SHUNT (22%) than R2RECONST (6%) or R3MGT (12%) (P = 0.03). Late (>48 hr) thrombosis rates were similar, whereas 60% of R2SHUNT thromboses occurred on day of injury (P = 0.003 vs. 25% and 0%). CONCLUSIONS: Staged femoropopliteal injury care is associated with similar limb salvage to initial role 3 management. Early thrombosis is likely because of shunt failure but does not lead to limb loss. Current military practice guidelines are appropriate and may inform civilian vascular injury management protocols.


Asunto(s)
Arteria Femoral/cirugía , Arteria Poplítea/cirugía , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/cirugía , Campaña Afgana 2001- , Amputación , Bases de Datos Factuales , Arteria Femoral/lesiones , Humanos , Irak , Recuperación del Miembro , Medicina Militar , Personal Militar , Arteria Poplítea/lesiones , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Transporte de Pacientes , Resultado del Tratamiento , Estados Unidos , Procedimientos Quirúrgicos Vasculares/efectos adversos
18.
Diving Hyperb Med ; 49(4): 283-290, 2019 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-31828747

RESUMEN

INTRODUCTION: Hearing loss (HL) is common in the adult working population. It is widely assumed that diving is a risk factor for HL. However, studies with sufficient follow-up comparing HL in divers to non-divers are limited. This study aimed to assess the hearing threshold (HT) of Royal Netherlands Navy divers who had been diving for more than 15 years and to compare it to the ISO standard 7029:2017 reference table. METHODS: In this 25-year retrospective cohort study the Royal Netherlands Navy Diving Medical Centre audited the medical records of 1,117 Navy divers. Yearly dive medical assessments were performed according to professional standards, including audiometry. HTs were compared to the ISO 7029:2017 reference table, including Z-distribution, using paired t-tests. RESULTS: Thirty-five divers were included who had been diving for 15 years or longer. The HT increased significantly in nine of the 16 measured frequencies, while the Z-score decreased significantly in nine of the 16 tested frequencies (eight in both ears). In the 25-year follow-up the pattern was more obvious, with one significantly increased HT, and 10 significantly decreased Z-scores. DISCUSSION: The absolute HT increases after 15 years of military diving, but less than would be expected from normal age-related deterioration. Moreover, when comparing Z-scores, this sample of divers actually hear better than non-divers. We conclude that military diving is not an increased risk for HL compared to regular occupational hazards and suggest withdrawing the requirement for routine yearly audiometric evaluation as part of a dive medical examination.


Asunto(s)
Buceo , Trastornos de la Audición , Pérdida Auditiva , Personal Militar/estadística & datos numéricos , Adulto , Audiometría , Umbral Auditivo/fisiología , Buceo/efectos adversos , Audición/fisiología , Trastornos de la Audición/etiología , Pérdida Auditiva/etiología , Humanos , Países Bajos , Estudios Retrospectivos
19.
J Int Soc Sports Nutr ; 16(1): 59, 2019 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-31823790

RESUMEN

BACKGROUND: British Army Phase One training exposes men and women to challenging distances of 13.5 km·d- 1 vs. 11.8 km·d- 1 and energy expenditures of ~ 4000 kcal·d- 1 and ~ 3000 kcal·d- 1, respectively. As such, it is essential that adequate nutrition is provided to support training demands. However, to date, there is a paucity of data on habitual dietary intake of British Army recruits. The aims of this study were to: (i) compare habitual dietary intake in British Army recruits undergoing Phase One training to Military Dietary Reference Values (MDRVs), and (ii) establish if there was a relative sex difference in dietary intake between men and women. METHOD: Researcher led weighed food records and food diaries were used to assess dietary intake in twenty-eight women (age 21.4 ± 3.0 yrs., height: 163.7 ± 5.0 cm, body mass 65.0 ± 6.7 kg), and seventeen men (age 20.4 ± 2.3 yrs., height: 178.0 ± 7.9 cm, body mass 74.6 ± 8.1 kg) at the Army Training Centre, Pirbright for 8-days in week ten of training. Macro and micronutrient content were estimated using dietary analysis software (Nutritics, Dublin) and assessed via an independent sample t-test to establish if there was a sex difference in daily energy, macro or micronutrient intakes. RESULTS: Estimated daily energy intake was less than the MDRV for both men and women, with men consuming a greater amount of energy compared with women (2846 ± 573 vs. 2207 ± 585 kcal·day- 1, p < 0.001). Both sexes under consumed carbohydrate (CHO) when data was expressed relative to body mass with men consuming a greater amount than women (4.8 ± 1.3 vs. 3.8 ± 1.4 g·kg- 1·day- 1, p = 0.025, ES = 0.74). Both sexes also failed to meet MDRVs for protein intake with men consuming more than women (1.5 ± 0.3 vs. 1.3 ± 0.3 g·kg- 1·day- 1, p > 0.030, ES = 0.67). There were no differences in dietary fat intake between men and women (1.5 ± 0.2 vs. 1.5 ± 0.5 g·kg- 1·day- 1, p = 0.483, ES = 0.00). CONCLUSIONS: Daily EI in men and women in Phase One training does not meet MDRVs. Interventions to increase macronutrient intakes should be considered along with research investigating the potential benefits for increasing different macronutrient intakes on training adaptations.


Asunto(s)
Dieta , Personal Militar , Acondicionamiento Físico Humano/fisiología , Factores Sexuales , Adolescente , Estudios Transversales , Registros de Dieta , Carbohidratos de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Ingestión de Energía , Metabolismo Energético , Femenino , Humanos , Masculino , Micronutrientes/administración & dosificación , Ingesta Diaria Recomendada , Adulto Joven
20.
Cyberpsychol Behav Soc Netw ; 22(12): 761-765, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31841649

RESUMEN

Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are highly prevalent, and frequently comorbid, among active and retired military service members. Both TBI and PTSD may contribute to impaired cognitive function, but it remains insufficiently clear what the relative impact of each is on overall cognition and whether multiple TBIs may further impair cognitive function. To understand the relative impact of TBI and symptoms of PTSD on cognitive function we examined data from 326 active or retired military service members, or dependents, either with or without a history of TBI, using questionnaires and the NIH Toolbox Cognitive Battery (NIH-TB), a brief iPad-based assessment that measures the cognitive domains most important to daily functioning. The NIH-TB was developed for use as a "common currency" among research studies, and was more recently adapted to the iPad for ease of use. To our knowledge, this is the first report of its application to evaluate the relative impact of TBI and PTSD. Our results indicate that cognitive function remains largely intact after multiple TBIs if symptoms of PTSD are not evident, and that measures of literacy and overall intelligence are relatively impervious to both TBI and PTSD. When cognitive impairment is observed after TBI, it is predominantly associated with the presence of significant symptoms of PTSD in most domains. However, TBI alone may impair some aspects of executive function. These findings need to be validated in other populations.


Asunto(s)
Lesiones Traumáticas del Encéfalo/psicología , Cognición , Disfunción Cognitiva/psicología , Personal Militar/psicología , Enfermedades Profesionales/psicología , Trastornos por Estrés Postraumático/psicología , Adulto , Disfunción Cognitiva/diagnóstico , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Enfermedades Profesionales/diagnóstico , Encuestas y Cuestionarios
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