Search Results (79)

Dog-assisted interventions (DAIs) are an established procedure to support military staff, but their implementation during active warfare has not yet been systematically studied. In addition, the welfare of therapy dogs participating in DAIs during war remains unexplored. Therapy dogs may develop clinically relevant emotional disorders, including trauma-related stress responses, analogous to human psychopathologies. The present study sought to monitor physiological arousal in therapy dogs performing DAI sessions with their handlers in two Ukrainian military hospitals (Vinnyzja and Kyiv). Biomarkers of hypothalamic–pituitary–adrenal (HPA) axis activity, including salivary, urinary, and hair cortisol concentrations, were assessed in Ukrainian (UA) therapy dogs to capture their acute and long-term stress responses. Additionally, cortisol levels in German (GE) therapy dogs performing similar DAIs under peaceful conditions were measured to compare cortisol levels between dogs from both regions. Results suggest that GE therapy dogs exhibited significantly higher urinary and hair cortisol levels and significantly lower salivary cortisol concentrations, reflecting alterations in longer-term glucocorticoid secretion that is possibly caused by war-related stimulation in the UA cohort. In contrast, no significant differences in salivary cortisol emerged as a consequence of performing DAIs. The present findings suggest that the environment rather than involvement in DAIs has an impact on therapy dogs’ cortisol secretion. Full article

Objectives: To develop and validate a transthoracic lung ultrasound (TLUS)-integrated clinical nomogram for predicting pulmonary arterial hypertension (PAH) in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). Methods: This multicenter retrospective study included 550 patients with CTD-ILD from the Second Affiliated Hospital of Fujian Medical University and 169 external cases from the Xijing Hospital, Fourth Military Medical University. Patients were randomly divided into a training cohort (n = 385) and an internal validation cohort (n = 165); the external dataset served as a testing cohort. Demographic, physiological, laboratory, pulmonary function, and TLUS data were collected. Univariate and multivariate logistic regression analyses identified independent predictors of PAH, which were used to construct a nomogram model. Discrimination was assessed using receiver operating characteristic (ROC) curves and area under the curve (AUC) values. Calibration, decision curve analysis (DCA), and clinical impact curves (CIC) were performed to evaluate model accuracy and clinical utility. Results: Five independent predictors were identified: respiratory rate, diffusing capacity of the lung for carbon monoxide (DLCO% predicted), TLUS score, red blood cell (RBC) count, and brain natriuretic peptide (BNP). The model achieved excellent discrimination with AUCs of 0.952 (95% confidence interval [CI]: 0.927–0.977) in the training cohort, 0.935 (95% CI: 0.885–0.985) in the validation cohort, and 0.874 (95% CI: 0.806–0.942) in the testing cohort, outperforming individual predictors. Calibration plots showed close agreement between predicted and observed probabilities, while DCA and CIC confirmed strong clinical benefit and applicability across all thresholds. Conclusions: This TLUS-integrated nomogram provides a noninvasive and reliable tool for individualized PAH risk assessment in CTD-ILD patients. By combining ultrasound findings with physiological and laboratory markers, the model enables accurate detection of high-risk cases and may assist clinicians in optimizing surveillance and management strategies. Full article

Background: Shoulder instability imposes a substantial burden in U.S. military populations, yet epidemiology and outcomes reporting is heterogeneous. This study aims to quantify the epidemiology of shoulder instability among U.S. active-duty servicemembers and to report operative management patterns and outcomes. Methods: A systematic review was performed by searching MEDLINE, EMBASE, Scopus, Cochrane, and SPORTDiscus through 1 August 2025. Eligible studies enrolled U.S. active-duty servicemembers with clinical and/or radiographic evidence of instability. After a single comprehensive search with uniform inclusion criteria, studies were assigned to two prespecified cohorts: (1) epidemiology (incidence, directionality, risk factors) and (2) operative management/outcomes (procedure distribution, failure, complications, return to duty [RTD] and return to sport [RTS]). Incidence was pooled as a person-years–weighted fixed-effect estimate; directionality proportions were meta-analyzed with random-effects (logit-transformed) models among patient-level, unidirectional cases. Results: Forty-nine studies were included (epidemiology, n = 8; outcomes, n = 41). Three epidemiologic datasets (42,310 events; 20,472,363 person-years) yielded a pooled military incidence of 2.07 per 1000 person-years (95% CI, 2.05–2.09). Among unidirectional cases (n = 916 shoulders), anterior instability comprised 83.9% (95% CI, 70.5–91.9) and posterior the remaining 16.1% (95% CI, 8.1–29.5). Outcome series most commonly reported arthroscopic Bankart repair (n = 933 shoulders), bony augmentation (e.g., Latarjet/Bristow; n = 700), posterior labral repair (n = 649), combined repairs (n = 511), and open Bankart (n = 442). Weighted mean failure ranged 4.7–23.6%; complications 5.2–10.9%; and reoperations 5.3–17.7%. RTD ranged 50.0–84.7% and RTS 4.8–75.0%. Conclusions: Shoulder instability in U.S. servicemembers occurs at rates exceeding population-based civilian estimates, with a relatively greater share of posterior and combined patterns. Operative outcomes vary substantially across procedures. Full article

Background: The post-acute sequelae of SARS-CoV-2 infection represent a growing public health concern. While associations between COVID-19 and metabolic disorders have been reported, less is known about this risk in young, healthy populations. This study aimed to quantify the risk of developing new-onset metabolic disorders following SARS-CoV-2 infection among U.S. active-duty service members. Methods: We conducted a propensity score-matched cohort study using U.S. Military Health System data between July 2020 and June 2021 of active-duty service members (ADSM) aged 18 to 65 years old. COVID-19 infections were identified through ICD-10 codes or laboratory results. A 1:2 matched cohort compared 103,789 COVID-19 exposed individuals with 207,578 controls. Outcomes included incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension (HTN), hyperlipidemia (HLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic syndrome (MetS) within one year. Cox proportional hazards models calculated adjusted hazard ratios (aHR) while controlling for obesity and overweight status. Results: The median age for both those with and without COVID-19 infection was 26 years (interquartile range 22–33 years), with males comprising the majority of participants (81.1% male, 18.9% female). COVID-19 infection was associated with significantly increased hazards for incident HTN (aHR 1.09; 95% CI, 1.01–1.18), HLD (aHR 1.30; 95% CI, 1.10–1.54), and MASLD (aHR 1.36; 95% CI, 1.15–1.60). However, no significant increased risk was observed for T2DM or MetS. Conclusions: COVID-19 infection was associated with significantly increased risk of developing HTN, HLD, and MASLD, highlighting important long-term metabolic consequences in a young, healthy population. Full article

Background and Objectives: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard in ST-segment elevation myocardial infarction (STEMI). Guidelines favor ticagrelor over clopidogrel, but their effect on infarct artery flow prior to percutaneous coronary intervention (PCI) remains debated. Objective was to compare the effects of aspirin + clopidogrel versus aspirin + ticagrelor pretreatment on infarct artery Thrombolysis in Myocardial Infarction (TIMI) flow in STEMI patients. Materials and Methods: This retrospective cohort study included first-time STEMI patients ≥ 18 years admitted to the Military Medical Academy, Belgrade (January 2016–January 2022), who received pretreatment with aspirin + clopidogrel or aspirin + ticagrelor and underwent PCI. TIMI flow was graded before and after PCI. Primary outcomes were pre- and post-PCI TIMI flow; secondary outcome was in-hospital mortality. Results: Of 299 STEMI patients, 174 received aspirin + ticagrelor and 125 received aspirin + clopidogrel. Pre-PCI TIMI flow was significantly higher in the ticagrelor group (p < 0.001), while post-PCI TIMI flow (p = 0.056) and in-hospital mortality (p = 0.083) did not significantly differ between groups. After exclusion of patients receiving glycoprotein IIb/IIIa inhibitors, the difference in PCI TIMI flow grade after PCI became statistically significant (p = 0.007), favoring the aspirin + ticagrelor group. In multivariate analysis, male gender, drug-eluting stent implantation, and glycoprotein IIb/IIIa inhibitor use were independently associated with reduced in-hospital mortality. Conclusions: In STEMI patients, ticagrelor-based DAPT was associated with better initial coronary flow compared to clopidogrel. However, this advantage was not evident after PCI. Male gender, drug-eluting stent implantation, and glycoprotein IIb/IIIa inhibitor use were associated with improved survival. Full article

Background: This retrospective case series examines incidental findings (IFs) detected on abdominopelvic CT (APCT) among young Korean soldiers presenting with acute abdominal pain. APCT is a frontline test for acute abdominal pain but frequently reveals incidental findings (IFs) unrelated to the presenting complaint. While many IFs are benign, some require structured follow-up. In military settings with constrained access and frequent personnel transfers, IFs pose challenges for health-system readiness. Methods: We retrospectively reviewed 1062 male Korean soldiers (18–28 years) who underwent APCT for acute abdominal pain at a military emergency department (ED) between January 2021 and December 2022. Two board-certified radiologists independently reassessed all scans to identify IFs and to classify those requiring follow-up based on contemporary guidelines. Results: IFs were identified in 218/1062 (20.5%) patients. Common categories included renal cysts (6.2%) and hepatobiliary IFs (7.5%). Clinically significant lesions comprised Bosniak IIF renal cysts (0.3%), inherited cystic kidney disease (0.2%), IPMN (0.1%), adrenal incidentalomas (0.4%), and appendiceal mucoceles (0.2%). An exploratory analysis suggested co-occurrence clusters (e.g., renal and hepatic cysts). Conclusions: IFs on APCT are prevalent even in a young, ostensibly healthy military cohort, highlighting a gap between detection and effective follow-up. Implementing structured reporting, automated tracking, and cross-institution referral pathways may mitigate long-term risk and support operational readiness in settings with limited subspecialty access and frequent relocations. Full article

Background/Objective: US military personnel deployed to the Middle East were potentially subjected to harmful exposures, such as carcinogens from burn pits, which may increase the risk of lymphoid malignancies. Our objective was to determine the association between deployment and the risk of developing lymphoid malignancies. Methods: This was a retrospective nested matched case-control study from a cohort of 3.5 million veterans who enlisted in the military after September 2001 and were followed until death or last follow up through September 2024. Cases of lymphoid malignancies were identified by the VA Central Cancer Registry and controls were randomly selected from the same base cohort, matched by year of birth, year of enlistment, sex, race, and ethnicity. Exposure was defined as deployment to the Middle East as determined by identification on the VA Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) roster with confirmed dates of deployment or paystubs. Results: There were 1037 cases of lymphoid malignancies and 3572 matched controls. Deployment was not associated with a higher risk of developing lymphoid malignancies compared to non-deployment. Exposure to OEF/OIF was not associated with a higher risk of developing certain types of lymphoid malignancies. Conclusions: In this large, matched case-control study of US veterans, deployment to the Middle East was not associated with increased risk of developing lymphoid malignancies. While these findings do not support an increased lymphoid malignancy risk, important limitations remain, including the absence of detailed exposure and potential confounding variables. Prospective monitoring of specific types and doses of exposures during military deployment, development of lymphoid and other malignancies, and their underlying pathophysiology is indicated. Full article

Background: The hepatitis A virus (HAV) is a major cause of acute viral hepatitis and a significant global health concern. This study provides a pre-vaccination baseline for Oman, enabling longitudinal comparison with post-hepatitis A vaccination cohorts. This study aimed to determine the pre-vaccination seroprevalence of HAV antibodies (anti-HAV) in Oman and explore the associated demographic factors. Methods: A cross-sectional study was conducted from April 2014 to August 2015 among patients attending the medical outpatient clinic of the Medical City Hospital for Military and Security Services. Demographic data were collected via a structured questionnaire, and serum samples were tested for anti-HAV immunoglobulin IgG and IgM using enzyme-linked immunosorbent assays. Multivariate analysis was performed to identify the predictors of anti-HAV seroprevalence. Results: Among 1975 participants, 88.1% were positive for anti-HAV IgG. The mean age was 37.4 ± 16.1 years; however, those negative for anti-HAV IgG were considerably younger (mean age: 24.8 ± 15.7 years). Anti-HAV IgG seroprevalence was 37% in individuals aged ≤18 years and 91% in those >18 years (p < 0.001). The factors associated with seropositivity included older age (p < 0.001), consuming food prepared outside the home (p < 0.001), occupation (p < 0.001), and education level (p = 0.003). In the multivariable analysis, only age showed a strong independent association with serostatus: per 10-year increase, the aOR for anti-HAV IgG seropositivity was 2.87 (95% CI 2.25–3.63; p < 0.001). Conclusions: Our study estimates show high anti-HAV IgG seroprevalence and serve as a pre-vaccination baseline for evaluating the hepatitis A vaccination program in Oman over time. Given the lower natural exposure among younger cohorts, continued routine vaccination, scheduled serosurveys, and strengthened surveillance are required to identify emerging immunity gaps and prevent future HAV outbreaks. Full article

Jet fuels are a complex mixture of hydrocarbons and performance additives, including some compounds with established human toxicity. They represent a significant occupational hazard for military personnel; however, little is known about possible long-term health effects, particularly following cessation of exposure. In response to United States (US) Veterans’ concerns, the US Department of Veterans Affairs (VA) and the Department of Defense (DoD) launched a large retrospective cohort study to assess the impact of military occupational jet fuel exposure on Veterans’ health. The Long-Term Impact of Fuel Exposure (LIFE) cohort consists of over 1.3 million Veterans who entered service on or after 1 January 1995, including both individuals with jet fuel-exposed occupations in their service history and a random sample of unexposed Veterans. Data from multiple VA and DoD administrative datasets were linked to evaluate morbidity, disability, and mortality endpoints. Analyses are underway to assess associations between jet fuel exposure and adverse health outcomes in multiple body systems. This study represents the largest effort to date to investigate these effects, with the intention of informing policies affecting Veterans for years to come. Full article

Moral injury is a discrete form of harm affecting individuals as a potentially avoidable consequence of exposure to a morally injurious event. That injury (independent of psychological injury or illness) has been identified as a cause of physical symptoms, suicide and suicidality. Originally identified within military and veteran cohorts, it is observable in emergency responders, healthcare providers, human rights advocates and others. Its aetiology suggests that other groups where the potential for tensions between personal morals, professional ethics and occupational activities arises (such as whistleblowers, law enforcement personnel and lawyers) may be at risk. Despite increasingly diverse evidence identifying moral injury as a substantive harm with significant consequences, the legal options for redress are unclear. This article explores whether requirements for establishing a duty of care as a precursor to a negligence claim are likely to pose an insurmountable obstacle for plaintiffs, including in the context of employer–employee duty relationships. It concludes that despite popular perceptions that negligence law is unlikely to be able to accommodate moral injury claims, a closer reading of key judgments indicates that there are opportunities for it to potentially be recognised as a harm on a principled basis—consistent with existing jurisprudence and legislation—for the purposes of establishing a duty of care. In the event that normative claims for its recognition are resisted, the justification for that resistance must be found outside historical development of legal principles from case law. Full article

Blast-induced polytrauma (BIPT) is a common injury among military personnel exposed to explosive blasts. It is increasingly recognized as a complex, multisystem disorder that extends beyond neurological damage to include systemic metabolic and inflammatory dysfunction. Adipokines, particularly leptin and adiponectin, are hormones secreted by adipose tissue and are emerging as key mediators in the pathophysiology of traumatic brain injuries. Yet, their long-term dynamics following blast exposure remain unclear. This study investigated the temporal profiles of plasma leptin and adiponectin in a longitudinal rat model of BIPT. Adult male Sprague Dawley rats were subjected to either a single (B) or repeated (BB) blast exposure (20 psi) or served as sham controls. Plasma samples were collected at 24 h, 1 month, 6 months, and 12 months post-exposure, and adipokine levels were measured using Enzyme-linked Immunosorbent Assay. Adiponectin levels exhibited a biphasic response: both B and BB groups showed significant early decrease at 24 h and 1 month compared to sham animals, followed by robust elevation at 6 and 12 months, particularly in the repeated blast group. In contrast, leptin levels remained unchanged acutely but rose significantly at 6 and 12 months post-blast, with the BB group again showing the highest levels. These patterns indicate sustained, exposure-dependent dysregulation of adipokine signaling after blast trauma. The study provides the first longitudinal profile of systemic adipokine responses to BIPT, revealing their potential as accessible biomarkers and therapeutic targets. These findings support a model of chronic metabolic and inflammatory imbalance in BIPT and warrant further investigation in human cohorts and mechanistic studies. Full article

Background: Limited data exist on the comparative diagnostic value of CT urography (CTU) versus unenhanced CT in evaluating the upper urinary tract in young adults (<50 years) with hematuria in active military service. This population may face an increased risk of urinary tract malignancies due to occupational exposures. Methods: We conducted a retrospective cohort study of 277 consecutive Israel Defense Forces personnel under 50 years old with new-onset hematuria referred for CT evaluation between 2011 and 2020. Two experienced radiologists first interpreted unenhanced CT images, followed by a review of contrast-enhanced phases. Findings were classified based on their detectability on unenhanced CT and whether contrast phases were required. Results: Of the 277 patients, 270 had microscopic hematuria and 7 had macroscopic hematuria. Imaging was normal in 158 cases. Among 119 patients (43%) with positive findings, 46 (16.6%) had clinically significant findings requiring follow-up or treatment. Of these, 42 (91%) were detectable on unenhanced CT alone. Contrast phases were requested in 15 cases (5.4%) and revealed additional benign findings. No urinary tract malignancies were identified. Conclusions: Unenhanced CT may be sufficient for evaluating new-onset hematuria in adults under 50, including active military personnel, minimizing the need for contrast administration. Full article

Post-traumatic stress disorder (PTSD) is a complex, debilitating condition prevalent among military personnel exposed to traumatic events, necessitating biomarkers for early detection and intervention. Using data from the Millennium Cohort Study, the largest and longest-running military health study initiated in 2001, our objective was to identify specific microRNA (miRNA) expression patterns associated with distinct PTSD symptom trajectories among service members and veterans and assess their potential for predicting resilience and symptom severity. We analyzed 1052 serum samples obtained from the Department of Defense Serum Repository and linked with survey data collected at baseline and across three follow-up waves (2001–2011), using miRNA sequencing and statistical modeling. Our analysis identified five PTSD trajectories—resilient, pre-existing, new-onset moderate, new-onset severe, and adaptive—and revealed significant dysregulation of three key miRNAs (miR-182-5p, miR-9-5p, miR-204-5p) in participants with PTSD compared to resilient individuals. These miRNAs, which inhibit brain-derived neurotrophic factor (BDNF) and target pathways like NFκB, Notch, and TGF-alpha, were associated with neuronal plasticity, inflammation, and tissue repair, reflecting PTSD pathophysiology. These findings suggest that miRNA profiles could serve as biomarkers for early identification of PTSD risk and resilience, guiding targeted interventions to improve long-term health outcomes for military personnel. Full article

Background/Objectives: Chronic low back pain (LBP) remains a leading cause of disability and healthcare utilization globally, with complex, multifactorial pathophysiology. Despite advances in imaging, diagnosis often remains challenging due to poor correlation between structural findings and clinical symptoms. Recent evidence suggests inflammatory mechanisms may underlie persistent pain. This study investigated whether systemic inflammatory cytokines are altered in military personnel with chronic LBP and examined their relationships with clinical manifestations, psychological factors, and radiological findings. Methods: In this cross-sectional study, we enrolled 50 patients with chronic non-specific LBP (duration ≥ 3 months) and 50 age-, sex-, and BMI-matched healthy controls. All patients underwent a comprehensive clinical assessment, which included evaluation of pain intensity (VAS), neuropathic pain screening (DN4), psychological assessment (HADS), fibromyalgia screening (FIRST), and assessment of functional disability (Oswestry Disability Index and Roland-Morris Disability Questionnaire, EIFEL). Serum levels of IL-6, IL-8, IL-1β, TNF-α, and IL-10 were measured using chemiluminescence and enzyme-linked immunosorbent assay (ELISA) techniques. Radiological findings were documented through MRI and CT imaging of the lumbar spine. Results: Serum IL-8 levels were significantly elevated in patients with chronic LBP compared to healthy controls (8.52 ± 6.7 vs. 4.8 ± 0.56 pg/mL, p < 0.001). Weak positive correlations were observed between IL-8 levels and anxiety scores (r = 0.3, p = 0.02) and functional disability, as measured by the EIFEL questionnaire (r = 0.3, p = 0.04); however, these associations did not remain significant after Bonferroni correction for multiple testing. Similarly, IL-6 showed a weak positive correlation with BMI (r = 0.21, p = 0.03) and a weak negative correlation with lumbar mobility, as assessed by Schober’s test (r = −0.38, p = 0.03), which also did not survive correction for multiple comparisons. Conclusions: This study identified serum IL-8 as a potential biomarker for chronic LBP. While we observed associations between specific inflammatory markers and psychological distress and functional disability, these correlations were weak and did not remain significant after correction for multiple testing. These preliminary findings suggest possible connections between inflammation and the psychophysiological aspects of chronic LBP that warrant further investigation in larger cohorts. Full article

Background/Objectives: Rotavirus gastroenteritis is a vaccine-preventable disease that leads to hospitalization in children less than 5 years of age. Immunizations to prevent rotavirus have greatly altered the epidemiology of significant diarrheal illness. It has been reported that routine immunization rates in children were impacted during the COVID-19 pandemic. Contrary to this fact, rates of many childhood illnesses also decreased. Methods: The Military Health System Data Repository (MDR) contains the health records of all military beneficiaries. We queried the MDR before and during the COVID-19 pandemic to assess for alterations in immunization rates and hospitalization rates and to assess for risk factors for significant (hospitalizations) rotavirus disease. Results: Our study included a cohort of 1.27 million children under the age of 5 years old. There were 186 unique cases of rotavirus-related hospitalizations over the 5-year study period. During COVID-19 Years 1 and 2, there was a decrease in rotavirus-related hospitalizations compared to the pre-pandemic period. During Year 3, there was a return to the pre-pandemic level of rotavirus hospitalization rates. Patients in the northern United States were less likely to be hospitalized from rotavirus when compared to those in the south. The patients at greatest risk were the youngest beneficiaries. Rotavirus vaccination rates declined in this age group during all three years of the pandemic. Conclusions: As the pandemic resulted in less frequent rotavirus immunizations in the Military Health System (MHS), there was not an increase in rotavirus-related hospitalizations above the pre-pandemic baseline. Full article