{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T05:48:39Z","timestamp":1745300919501,"version":"3.37.3"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"Supplement_3","license":[{"start":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T00:00:00Z","timestamp":1724025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,19]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Definitive management of non-compressible intra-abdominal hemorrhage (NCIAH) currently requires a surgeon and operating room capable of performing damage control surgery. In a wartime scenario or a geographically remote environment, these may not be readily available. In this study, we sought to test the safety of 2 emerging injectable hemostatic agents (CounterFlow and Fast Onset Abdominal Management, or FOAM, poloxamer component) versus normal saline control over a prolonged monitoring duration following administration by a non-surgical provider.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>The Institutional Animal Care and Use Committee approved all research conducted in this study. We randomized male New Zealand white rabbits into 2 monitoring cohorts of 24\u2009hours and 2\u2009weeks. Each cohort contained 3 treatment groups (n\u2009=\u20094 rabbits\/group): CounterFlow, the testable poloxamer component of FOAM, and normal saline control. We injected each treatment intraperitoneally in the left lower abdominal quadrant. Doses were 15\u2009mL\/kg for CounterFlow, 6.3\u2009mL\/kg for the poloxamer component of FOAM, and 15\u2009mL\/kg for normal saline. We conducted all injections under isoflurane anesthesia monitored by trained veterinary staff. Animals were euthanized at each cohort end point, and a veterinary pathologist blinded to treatment type performed necropsy. The primary outcome was incidence of intra-abdominal adhesions at necropsy. Quantitatively, adhesions when present were graded by the veterinary pathologist on a 1 to 4 scale, where \u201c1\u201d represented adhesions involving from 1 to 25% of the examined abdomen, \u201c2\u201d represented from 26 to 50%, \u201c3\u201d represented from 51 to 75%, and \u201c4\u201d represented from 76 to 100%. Qualitatively, adhesions present were graded by degree (\u201c1\u201d\u2009=\u2009minimal, \u201c2\u201d\u2009=\u2009mild, \u201c3\u201d\u2009=\u2009moderate, and \u201c4\u201d\u2009=\u2009severe) and chronicity (\u201c1\u201d\u2009=\u2009acute, \u201c2\u201d\u2009=\u2009subacute, and \u201c3\u201d\u2009=\u2009chronic). We also drew d-dimer blood values and measured body weights for each animal. Statistical analysis included either repeated measures 2-way ANOVA or a mixed-effects model (in the case of missing data) with Geisser\u2013Greenhouse correction. We adjusted multiple comparisons using Tukey statistical hypothesis tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the 2-week cohort, 3 CounterFlow animals showed adhesions judged to be \u201c1\u201d quantitatively. Qualitatively, 2 of these were assessed as \u201c1\u201d for degree of adhesions and the other demonstrated a \u201c2.\u201d On the chronicity of adhesions scale, 1 animal demonstrated a \u201c2\u201d and 2 demonstrated a \u201c3.\u201d No animals in other groups (FOAM and control) demonstrated adhesions. CounterFlow-treated animals showed a statistically significant rise in d-dimer values in the 24-hour cohort only. In the 2-week cohort, CounterFlow-treated animals showed a decrease in body weight at 24\u2009hours after injection but returned to their baseline (normal) body weights at 7\u2009days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Findings from this study demonstrate that the tested ingredients of FOAM poloxamer component are safe for intraperitoneal injection and hold potential for further study directed toward prehospital non-compressible intra-abdominal hemorrhage management by non-surgical providers. Although CounterFlow produced abdominal adhesions in 3 of 4 rabbits in the 2-week cohort, these were determined to be \u201cminimal\u201d or \u201cmild\u201d in degree.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae053","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T16:10:17Z","timestamp":1724083817000},"page":"99-105","source":"Crossref","is-referenced-by-count":1,"title":["Incidence of Intra-abdominal Adhesions Following Intraperitoneal Injection of Hemostatic Products in Rabbits"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2416-7262","authenticated-orcid":false,"given":"Zachary C","family":"Booms","sequence":"first","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert V","family":"Hainline","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilee C","family":"Venn","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irasema B","family":"Terrazas","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Barraza","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiffany K","family":"Geisen","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie M","family":"Marshall","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana N","family":"Torres","sequence":"additional","affiliation":[{"name":"59th Medical Wing , JBSA Lackland, TX 78236, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathy L","family":"Ryan","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas H","family":"Edwards","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,8,19]]},"reference":[{"issue":"4","key":"2024082004005381200_R1","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/j.suc.2012.05.002","article-title":"Noncompressible torso hemorrhage: a review with contemporary definitions and management strategies","volume":"92","author":"Morrison","year":"2012","journal-title":"Surg Clin N Am"},{"issue":"6","key":"2024082004005381200_R2","doi-asserted-by":"publisher","first-page":"S431","DOI":"10.1097\/TA.0b013e3182755dcc","article-title":"Death on the battlefield (2001-2011): implications for the future of combat casualty care","volume":"73","author":"Eastridge","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"2024082004005381200_R3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/SLA.0000000000005787","article-title":"The golden hour of casualty care: rapid handoff to surgical team is associated with improved survival in war-injured US service members","volume":"279","author":"Shackelford","year":"2024","journal-title":"Ann Surg"},{"issue":"2","key":"2024082004005381200_R4","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/TA.0000000000000507","article-title":"Efficacy of a prehospital self-expanding polyurethane foam for noncompressible hemorrhage under extreme operational conditions","volume":"78","author":"Rago","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"issue":"5","key":"2024082004005381200_R5","doi-asserted-by":"publisher","first-page":"1603","DOI":"10.1016\/j.injury.2022.01.024","article-title":"Percutaneous delivery of self-propelling hemostatic powder for managing non-compressible abdominal hemorrhage: a proof-of-concept study in swine","volume":"53","author":"Cau","year":"2022","journal-title":"Injury"},{"issue":"1","key":"2024082004005381200_R6","doi-asserted-by":"publisher","first-page":"25","DOI":"10.3138\/jmvfh-2022-0014","article-title":"Efficacy and safety of CounterFlow in animal models of hemorrhage","volume":"9","author":"Peng","year":"2023","journal-title":"J Mil Veteran Fam Health"},{"issue":"2S Suppl 1","key":"2024082004005381200_R7","doi-asserted-by":"publisher","first-page":"S86","DOI":"10.1097\/TA.0000000000003670","article-title":"Percutaneous delivery of self-propelling thrombin-containing powder increases survival from noncompressible truncal hemorrhage in a swine model of coagulopathy and hypothermia","volume":"93","author":"Cau","year":"2022","journal-title":"J Trauma Acute Care Surg"},{"key":"2024082004005381200_R8","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.jss.2020.11.039","article-title":"Thermoreversible reverse-phase-shift foam for treatment of noncompressible torso hemorrhage","volume":"259","author":"Donaldson","year":"2021","journal-title":"J Surg Res"},{"issue":"1","key":"2024082004005381200_R9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40779-020-00241-z","article-title":"Hemostatic agents for prehospital hemorrhage control: a narrative review","volume":"7","author":"Peng","year":"2020","journal-title":"Military Med Res"},{"issue":"11\u201312","key":"2024082004005381200_R10","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1093\/milmed\/usac206","article-title":"Thermoreversible reverse-phase-shift foam for treatment of noncompressible torso hemorrhage, a safety trial in a porcine model","volume":"188","author":"Donaldson","year":"2022","journal-title":"Mil Med"},{"issue":"11","key":"2024082004005381200_R11","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1001\/jama.2014.2135","article-title":"Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study","volume":"311","author":"Righini","year":"2014","journal-title":"JAMA"},{"issue":"8","key":"2024082004005381200_R12","doi-asserted-by":"publisher","first-page":"5572","DOI":"10.1021\/acs.cgd.0c00741","article-title":"Calcium carbonate particle formation through precipitation in a stagnant bubble and a bubble column reactor","volume":"20","author":"Grimes","year":"2020","journal-title":"Cryst Growth Des"},{"issue":"13","key":"2024082004005381200_R13","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1056\/NEJMoa023153","article-title":"Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis","volume":"349","author":"Wells","year":"2003","journal-title":"N Engl J Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/Supplement_3\/99\/58855289\/usae053.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/Supplement_3\/99\/58855289\/usae053.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T04:01:21Z","timestamp":1724126481000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/Supplement_3\/99\/7735888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,19]]},"references-count":13,"journal-issue":{"issue":"Supplement_3","published-online":{"date-parts":[[2024,8,19]]},"published-print":{"date-parts":[[2024,8,19]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usae053","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2024,9]]},"published":{"date-parts":[[2024,8,19]]}}}