Search NASA⌕ Search

SEARCH · Search NASA

Results for “TRAUMA”

Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 records
All sourcesNASA NTRSDOE OSTI
DOE OSTI2025

Modeling Sepsis: Establishment and Validation of a 72-Hour Swine Model of Penetrating Abdominal Trauma

Background/Objectives: Fecal peritonitis following penetrating abdominal trauma is a serious condition that often results in sepsis and organ failure. The aim of our study was to develop a novel conscious porcine model of sepsis and organ dysfunction caused by multiple penetrating injuries to the small and large intestines. Methods: Twelve female Yorkshire pigs (average weight 50.6 ± 6.5 kg) were divided into two groups: Penetrating Abdominal Trauma (PAT) (n = 8) and Control (n = 4). All surgical procedures were performed under anesthesia with adequate analgesia. In the PAT group, the small and large intestines were punctured, and feces mixed with saline were introduced into the abdominal cavity to induce peritonitis. The Control group received sham surgery with only saline solution. The animals were observed in a conscious state over a period of 72 h, vital parameters were recorded, and blood samples were taken regularly. We adapted a pig-specific SOFA score and developed pig-specific SIRS criteria and NEWS2 score to assess organ function. The model was validated by independent investigators. Results: The survival rate in the PAT group was 75%, with an average survival time of 58.5 h, while all animals in the Control group survived to euthanasia. Monitoring showed pathophysiological changes, such as tachycardia, leucopenia, and thrombocytopenia, indicative of sepsis and organ dysfunction. Blinded investigators independently confirmed the model’s validity. Conclusions: A new swine model of penetrating abdominal trauma and sepsis has been successfully developed that demonstrates significant physiological and immunologic changes comparable to human sepsis. This new model provides a realistic platform for future research into sepsis, its diagnostics, and the evaluation of therapeutic strategies.

General & Internal Medicine↗
DOE OSTI2022

Backpack electrofishing does not contribute to external signs of gas bubble trauma in sculpins

Abstract We exposed prickly sculpin Cottus asper and reticulate sculpin Cottus perplexus to electroshock and sham treatments in a controlled laboratory setting to determine if backpack electrofishing contributed to or exacerbated external signs of gas bubble trauma (GBT) in fish exposed to elevated total dissolved gas (TDG) levels. Fish were exposed to 115, 120 and 125% TDG (measured as percent of saturation) for various amounts of time (24–144 h) then subjected to a 5‐s electroshock or sham treatment of no electroshock. Fish were examined to determine the incidence of GBT pre‐ and post‐treatment, and all aspects (i.e., dorsal, ventral, left and right sides) of each fish were photographed. Across all TDG levels in all trials, no sculpin showed any change in GBT incidence following treatment. Analysis of GBT signs evident in photographs of 68 fish found no evidence of change in mean pre‐ and post‐treatment gas bubble sizes in fish in any TDG trial, nor were any new gas bubbles found following treatment. We are aware of no physiological mechanism by which backpack electrofishing can cause GBT in sculpin, and as such, we believe using this gear should not increase GBT incidence rates in sculpin.

Tiffan, Kenneth F.↗
DOE OSTI2019

Computed tomography (CT) in the evaluation of bladder and ureteral trauma: indications, technique, and diagnosis

Introduction: Trauma to the genitourinary system includes blunt and penetrating injuries to bladder and ureters. These are rare injuries and are overlooked as other abdominal and pelvic injuries often take priority. Delayed diagnosis can lead to significant morbidity and mortality. Computed tomography has taken a central role in the imaging of the ureters and bladder. Methods: This article reviews the anatomic relationships, mechanisms of injury, and clinical presentation to help physicians determine when bladder and ureteral injuries should be suspected and further imaging should be pursued. Radiologic evaluation of bladder and ureteral injury with CT cystography and CT urography, respectively, will be reviewed. Conclusion: CT cystography and CT urography are effective tools in identifying potentially serious injuries to the genitourinary system. Timely recognition of these injuries can be crucial for the overall management and prognosis.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2023

An extended focused assessment with sonography in trauma ultrasound tissue-mimicking phantom for developing automated diagnostic technologies

Medical imaging-based triage is critical for ensuring medical treatment is timely and prioritized. However, without proper image collection and interpretation, triage decisions can be hard to make. While automation approaches can enhance these triage applications, tissue phantoms must be developed to train and mature these novel technologies. Here, we have developed a tissue phantom modeling the ultrasound views imaged during the enhanced focused assessment with sonography in trauma exam (eFAST). The tissue phantom utilized synthetic clear ballistic gel with carveouts in the abdomen and rib cage corresponding to the various eFAST scan points. Various approaches were taken to simulate proper physiology without injuries present or to mimic pneumothorax, hemothorax, or abdominal hemorrhage at multiple locations in the torso. Multiple ultrasound imaging systems were used to acquire ultrasound scans with or without injury present and were used to train deep learning image classification predictive models. Performance of the artificial intelligent (AI) models trained in this study achieved over 97% accuracy for each eFAST scan site. We used a previously trained AI model for pneumothorax which achieved 74% accuracy in blind predictions for images collected with the novel eFAST tissue phantom. Grad-CAM heat map overlays for the predictions identified that the AI models were tracking the area of interest for each scan point in the tissue phantom. Overall, the eFAST tissue phantom ultrasound scans resembled human images and were successful in training AI models. Tissue phantoms are critical first steps in troubleshooting and developing medical imaging automation technologies for this application that can accelerate the widespread use of ultrasound imaging for emergency triage.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2019

Multimodality imaging of the male urethra: trauma, infection, neoplasm, and common surgical repairs

Objective: The aim of this article is to describe the indications and proper technique for RUG and MRI, their respective image findings in various disease states, and the common surgical techniques and imaging strategies employed for stricture correction. Results: Because of its length and passage through numerous anatomic structures, the adult male urethra can undergo a wide array of acquired maladies, including traumatic injury, infection, and neoplasm. For the urologist, imaging plays a crucial role in the diagnosis of these conditions, as well as complications such as stricture and fistula formation. While retrograde urethrography (RUG) and voiding cystourethrography (VCUG) have traditionally been the cornerstone of urethral imaging, MRI has become a useful adjunct particularly for the staging of suspected urethral neoplasm, visualization of complex posterior urethral fistulas, and problem solving for indeterminate findings at RUG. Conclusions: Familiarity with common urethral pathology, as well as its appearance on conventional urethrography and MRI, is crucial for the radiologist in order to guide the treating urologist in patient management.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2021

Creation of a prototype biomimetic fish to better understand impact trauma caused by hydropower turbine blade strikes

Biomimetic model organisms could be useful surrogates for live animals in many applications if the models have sufficient biofidelity. One such application is for use in field and laboratory tests of fish mortality associated with passage through hydropower turbines. Laboratory trials suggest that blade strikes are especially injurious and often causes mortality when fish are struck by thinner blades moving at higher velocities. Dose-response relationships have been created from these data, but the exact relationship between fish mortality and the actual forces enacted on fish during simulated blade strike testing remains unknown. Here, we describe the methods used to create a prototype biomimetic model fish composed of ballistic gelatin and covered with a surrogate skin to better approximate the biomechanical properties of a fish body. Frozen fish were scanned with high-fidelity laser scanners, and a 3D-printed, reusable mold was created from which to cast our gelatin model. Computed tomography scan data, imaged directly or taken from online data repositories, were also successfully used to create CAD models for use in additive manufacturing of molds. One 3-axis accelerometer was embedded into the gelatin to compare accelerometer data to dose-response data from previous laboratory research on live fish. The resulting model ( i.e. , Gelfish) had a statistically indistinguishable tissue durometer to that of real fish tissue and preliminary blade strike impact testing suggested its overall flexibility was similar to that of live fish. Gelfish was designed with biofidelity as its guiding principle and our results suggest initial experimentation was successful. Future research will include replication of initial Gelfish test results, quantitative measurement of model flexibility relative to real fish, and inclusion of surrogate skeletal structures to enhance biofidelity. Use of more sophisticated sensors would also better quantify the physical forces of blade strike impact and help determine how said forces correlate with rates of mortality observed during tests on live fish.

36 MATERIALS SCIENCE↗
DOE OSTI2024

Optimization of a Lethal, Combat-Relevant Model of Sterile Inflammation in Mice for Drug Candidate Screening

ABSTRACT Introduction Extensive trauma, commonly seen in wounded military Service Members, often leads to a severe sterile inflammation termed systemic inflammatory response syndrome (SIRS), which can progress to multiple organ dysfunction syndrome (MODS) and death. MODS is a serious threat to wounded Service Members, historically causing 10% of all deaths in trauma admissions at a forward deployed combat hospital. The importance of this problem will be exacerbated in large-scale combat operations, in which evacuation will be delayed and care of complex injuries at lower echelons of care may be prolonged. The main goal of this study was to optimize an existing mouse model of lethal SIRS/MODS as a therapeutic screening platform for the evaluation of immunomodulatory drugs. Materials and Methods Male C57BL/6 mice were euthanized, and the bones and muscles were collected and blended into a paste termed tissue–bone matrix (TBX). The TBX at 12.5%–20% relative to body weight of each recipient mouse was implanted into subcutaneous pouches created on the dorsum of anesthetized animals. Mice were observed for clinical scores for up to 48 hours postimplantation and euthanized at the preset point of moribundity. To test effects of anesthetics on TBX-induced mortality, animals received isoflurane or ketamine/xylazine (K/X). In a separate set of studies, mice received TBX followed by intraperitoneal injection with 20 mg/kg or 40 mg/kg Eritoran or a placebo carrier. All Eritoran studies were performed in a blinded fashion. Results We observed that K/X anesthesia significantly increased the lethality of the implanted TBX in comparison to inhaled anesthetics. Although all the mice anesthetized with isoflurane and implanted with 12.5% TBX survived for 24 hours, 60% of mice anesthetized with K/X were moribund by 24 hours postimplantation. To mimic more closely the timing of lethal SIRS/MODS following polytrauma in human patients, we extended observation to 48 hours. We performed TBX dose–response studies and found that as low as 15%, 17.5%, and 20% TBX caused moribundity/mortality in 50%, 80%, and 100% mice, respectively, over a 48-hour time period. With 17.5% TBX, we tested if moribundity/mortality could be rescued by anti-inflammatory drug Eritoran, a toll-like receptor 4 antagonist. Neither 20 mg/kg nor 40 mg/kg doses of Eritoran were found to be effective in this model. Conclusions We optimized a TBX mouse model of SIRS/MODS for the purpose of evaluating novel therapeutic interventions to prevent trauma-related pathophysiologies in wounded Service Members. Negative effects of K/X on lethality of TBX should be further evaluated, particularly in the light of widespread use of ketamine in treatment of pain. By mimicking muscle crush, bone fracture, and necrosis, the TBX model has pleiotropic effects on physiology and immunology that make it uniquely valuable as a screening tool for the evaluation of novel therapeutics against trauma-induced SIRS/MODS.

General & Internal Medicine↗
DOE OSTI2022

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.

42 ENGINEERING↗
DOE OSTI2021

Lifetime risk of suicide among survivors of the atomic bombings of Japan

Abstract Aims The long-term physical health effects of the atomic bombings of Hiroshima and Nagasaki are well characterised, but the psychological effects remain unclear. Therefore, we sought to determine whether measures of exposure severity, as indirect measures of psychological trauma arising from exposure to the atomic bombings, are associated with suicide mortality among atomic bomb survivors. Methods The Life Span Study is a prospective cohort study of 93 741 Japanese atomic bomb survivors who were located within 10 km of the hypocentre in Hiroshima or Nagasaki at the time of the bombings in 1945, and 26 579 residents of Hiroshima and Nagasaki who were not in either city at the time of the bombings, matched to survivors on city, sex and age. Measures of exposure severity included: proximity to the hypocentre, type of shielding between the survivor and the blast and self-reported occurrence of acute radiation and thermal injuries. Date of death was obtained from the Japanese National Family Registry system. Cause of death was obtained from death certificates. Adjusted hazard ratios (HRs) were estimated from Cox regression models overall and stratified by sex and age. Results During the 60-year follow-up period (1950–2009), 1150 suicide deaths were recorded among 120 231 participants (23.6 per 100 000 person-years): 510 among 70 092 women (17.2 per 100 000 person-years) and 640 among 50 139 men (33.6 per 100 000 person-years). Overall, there was no association of proximity, type of shielding or the occurrence of acute injuries with suicide mortality. Among those <25 years of age at the time of the bombings, increased suicide risk was observed for survivors outside v . shielded inside any structure (HR: 1.24; 95% confidence interval (CI): 1.03, 1.48; interaction p = 0.054) and for those who reported flash burns (HR: 1.32; 95% CI: 1.00, 1.73; interaction p = 0.025). Sex-stratified analyses indicated that these associations were limited to men. Among women, closer proximity to the hypocentre was associated with a non-significant increase in suicide risk, with a positive association between proximity and suicide risk observed among women <15 years of age (HR: 1.09 per km; 95% CI: 1.00, 1.18; interaction p = 0.067). Conclusions Proximity to the hypocentre, shielding and acute injury presence do not generally appear to influence suicide mortality among atomic bomb survivors. However, heterogeneity may exist by age and sex, with younger survivors potentially more sensitive to psychological trauma. Coupled with other studies, our results suggest the importance of long-term monitoring of mental health among young populations exposed to catastrophic events or mass trauma.

Psychiatry↗
DOE OSTI2022

Development of a Modular Tissue Phantom for Evaluating Vascular Access Devices

Central vascular access (CVA) may be critical for trauma care and stabilizing the casualty. However, it requires skilled personnel, often unavailable during remote medical situations and combat casualty care scenarios. Automated CVA medical devices have the potential to make life-saving therapeutics available in these resource-limited scenarios, but they must be properly designed. Unfortunately, currently available tissue phantoms are inadequate for this use, resulting in delayed product development. Here, we present a tissue phantom that is modular in design, allowing for adjustable flow rate, circulating fluid pressure, vessel diameter, and vessel positions. The phantom consists of a gelatin cast using a 3D-printed mold with inserts representing vessels and bone locations. These removable inserts allow for tubing insertion which can mimic normal and hypovolemic flow, as well as pressure and vessel diameters. Trauma to the vessel wall is assessed using quantification of leak rates from the tubing after removal from the model. Lastly, the phantom can be adjusted to swine or human anatomy, including modeling the entire neurovascular bundle. Overall, this model can better recreate severe hypovolemic trauma cases and subject variability than commercial CVA trainers and may potentially accelerate automated CVA device development.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2022

An image classification deep-learning algorithm for shrapnel detection from ultrasound images

Ultrasound imaging is essential for non-invasively diagnosing injuries where advanced diagnostics may not be possible. However, image interpretation remains a challenge as proper expertise may not be available. In response, artificial intelligence algorithms are being investigated to automate image analysis and diagnosis. Here, we highlight an image classification convolutional neural network for detecting shrapnel in ultrasound images. As an initial application, different shrapnel types and sizes were embedded first in a tissue mimicking phantom and then in swine thigh tissue. The algorithm architecture was optimized stepwise by minimizing validation loss and maximizing F1 score. The final algorithm design trained on tissue phantom image sets had an F1 score of 0.95 and an area under the ROC curve of 0.95. It maintained higher than a 90% accuracy for each of 8 shrapnel types. When trained only on swine image sets, the optimized algorithm format had even higher metrics: F1 and area under the ROC curve of 0.99. Overall, the algorithm developed resulted in strong classification accuracy for both the tissue phantom and animal tissue. This framework can be applied to other trauma relevant imaging applications such as internal bleeding to further simplify trauma medicine when resources and image interpretation are scarce.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2023

Cdk5 mediates rotational force-induced brain injury

Abstract Millions of traumatic brain injuries (TBIs) occur annually. TBIs commonly result from falls, traffic accidents, and sports-related injuries, all of which involve rotational acceleration/deceleration of the brain. During these injuries, the brain endures a multitude of primary insults including compression of brain tissue, damaged vasculature, and diffuse axonal injury. All of these deleterious effects can contribute to secondary brain ischemia, cellular death, and neuroinflammation that progress for weeks, months, and lifetime after injury. While the linear effects of head trauma have been extensively modeled, less is known about how rotational injuries mediate neuronal damage following injury. Here, we developed a new model of repetitive rotational head trauma in rodents and demonstrated acute and prolonged pathological, behavioral, and electrophysiological effects of rotational TBI (rTBI). We identify aberrant Cyclin-dependent kinase 5 (Cdk5) activity as a principal mediator of rTBI. We utilized Cdk5-enriched phosphoproteomics to uncover potential downstream mediators of rTBI and show pharmacological inhibition of Cdk5 reduces the cognitive and pathological consequences of injury. These studies contribute meaningfully to our understanding of the mechanisms of rTBI and how they may be effectively treated.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2021

Compensatory reserve detects subclinical shock with more expeditious prediction for need of life‐saving interventions compared to systolic blood pressure and blood lactate

Abstract Introduction We conducted a prospective observational study on 205 trauma patients at a level I trauma facility to test the hypothesis that a compensatory reserve measurement (CRM) would identify higher risk for progression to shock and/or need a life‐saving interventions (LSIs) earlier than systolic blood pressure (SBP) and blood lactate (LAC). Methods A composite outcome metric included blood transfusion, procedural LSI, and mortality. Discrete measures assessed as abnormal (ab) were SBP <90 mmHg, CRM <60%, and LAC >2.0. A graded categorization of shock was defined as: no shock (normal [n] SBP [n‐SBP], n‐CRM, n‐LAC); sub‐clinical shock (ab‐CRM, n‐SBP, n‐LAC); occult shock (n‐SBP, ab‐CRM, ab‐LAC); or overt shock (ab‐SBP, ab‐CRM, ab‐LAC). Results Three patients displayed overt shock, 53 displayed sub‐clinical shock, and 149 displayed no shock. After incorporating lactate into the analysis, 86 patients demonstrated no shock, 25 were classified as sub‐clinical shock, 91 were classified as occult shock, and 3 were characterized as overt shock. Each shock subcategory revealed a graded increase requiring LSI and transfusion. Initial CRM was associated with progression to shock (odds ratio = 0.97; p < .001) at an earlier time than SBP or LAC. Conclusions Initial CRM uncovers a clinically relevant subset of patients who are not detected by SBP and LAC. Our results suggest CRM could be used to more expeditiously identify injured patients likely to deteriorate to shock, with requirements for blood transfusion or procedural LSI.

Convertino, Victor A.↗
DOE OSTI2020

An investigation into the potential for wind turbines to cause barotrauma in bats

The high rates of bat mortality caused by operating wind turbines is a concern for wind energy and wildlife stakeholders. One theory that explains the mortality is that bats are not only killed by impact trauma, but also by barotrauma that results from exposure to the pressure variations caused by rotating turbine blades. To date, no published research has calculated the pressure changes that bats may be exposed to when flying near wind turbines and then used these data to estimate the likelihood that turbines cause barotrauma in bats. To address this shortcoming, we performed computational fluid dynamics simulations of a wind turbine and analytical calculations of blade-tip vortices to estimate the characteristics of the sudden pressure changes bats may experience when flying near a utility-scale wind turbine. Because there are no data available that characterize the pressure changes that cause barotrauma in bats, we compared our results to changes in pressure levels that cause barotrauma and mortality in other mammals of similar size. This comparison shows that the magnitude of the low-pressures bats experience when flying near wind turbines is approximately 8 times smaller than the pressure that causes mortality in rats, the smallest mammal for which data are available. The magnitude of the high-pressures that bats may experience are approximately 80 times smaller than the exposure level that causes 50% mortality in mice, which have a body mass similar to several bat species that are killed by wind turbines. Further, our results show that for a bat to experience the largest possible magnitude of low- and high-pressures, they must take very specific and improbable flight paths that skim the surface of the blades. Even a small change in the flight path results in the bat being hit by the blade or experiencing a much smaller pressure change. Accordingly, if bats have a physiological response to rapid low- and high-pressure exposure that is similar to other mammals, we conclude that it is unlikely that barotrauma is responsible for a significant number of turbine-related bat fatalities, and that impact trauma is the likely cause of the majority of wind-turbine-related bat fatalities.

17 WIND ENERGY↗
DOE OSTI2020

In-situ X-ray Evaluation of Traumatic Brain Injury Dynamic Impacts (Final Report)

The goal of this project was to create an in-situ model of traumatic brain injury that allows for analysis of chronic traumatic encephalopathy (CTE) development. CTE is a neurodegenerative disease that occurs as a result of traumatic brain injuries. The resulting neurodegeneration and atrophying of cortical brain tissue develop as tau proteins build-up around small blood vessels and at the base of cortical sulci. Aggregation of tau proteins results in blood vessel damage and neurological function loss, leading to cortical tissue atrophy. This occurs only at some neuronal junctions in the brain after trauma. It has been conjectured that the geometrical distribution of force along neurons is responsible for initiation of tau deposition. However, to assess the validity of this proposition, it is necessary to analyze the mechanical response under dynamic loading associated with brain trauma in-situ

42 ENGINEERING↗
DOE OSTI2025

Hardware-in-Loop Modules for Testing Automated Ventilator Controllers

Automated ventilator controllers have the potential to simplify oxygen and carbon dioxide management for trauma. In the pre-hospital or military medicine environment, trauma care can be required for prolonged periods by personnel with limited ventilator management training. As such, there is a need for closed-loop control systems that can adapt ventilator management to a complex, ever-changing medical environment. Here, we present a novel hardware-in-loop test platform for the independent troubleshooting and evaluation of oxygen and carbon dioxide automated ventilator management capabilities. The oxygen management system provides an analogue blood oxygen signal that is responsive to the fraction of inspired oxygen and the peak inspiratory pressure ventilator settings. A tested oxygenation controller successfully reached the target oxygen saturation within 5 min. The carbon dioxide removal system integrates with commercial ventilator technology and mimics carbon dioxide generation, lung compliance, and airway resistance while providing an end-tidal carbon dioxide level that is responsive to changes in the tidal volume and respiratory rate settings. A test mechanical ventilator controller was able to regulate EtCO2 regardless of the starting value within 10 min. This highlights the system’s functionality and provides proof-of-concept demonstrations for how the hardware-in-loop test platforms can be used for evaluating closed-loop controller technologies.

Berard, David (ORCID:0000000322863846)↗