Summary comments from workshop day 1: nutritional armor for the warfighter--can omega-3 fatty acids enhance stress resilience, wellness, and military performance?

The first day of this conference reviewed the literature on the intake of omega-3 fatty acids, in all forms, around the world. Clinical trials using omega-3 fatty acids for a variety of pathological conditions, and studies examining omega-3 supplementation in nonclinical populations, were examined. Finally, the basic science describing possible mechanisms for observed clinical effects was reviewed. Despite wide recognition that the minute levels needed to prevent clinical deficiency are probably not optimal for health, there is a dearth of information on intake needed to optimize performance among healthy populations. Randomized placebo-controlled trials in humans specially evaluating health outcomes relevant to military populations are needed. Widespread consensus must be built on solid evidence of appropriate intake, both in absolute terms and as a percentage of total fat, before a recommendation to change the intake of omega-3 fatty acids in the Department of Defense is made.

Laparoscopic heminephrectomy using a new fibrin sealant powder.

OBJECTIVES: To determine the ability of a hemostatic fibrin sealant powder (HFSP), delivered laparoscopically, to achieve hemostasis and seal the collecting system during laparoscopic heminephrectomy. METHODS: An HFSP preparation was applied laparoscopically as a dry powder spray. Twenty-two farm pigs were randomized into two laparoscopic heminephrectomy groups: group 1 underwent conventional intracorporal suturing with vascular control (n = 11) and group 2 received HFSP application alone with regional ischemia (n = 11). Computed tomography was performed at 48 hours and again 6 weeks postoperatively. RESULTS: The operative findings revealed no differences between the two groups in the weight of the removed segments, mean arterial blood pressure, operating room time, estimated blood loss, or hematocrit and serum creatinine levels. The gross examination 6 weeks postoperatively found no delayed bleeding, urinoma formation, or bowel adhesions. The computed tomography findings at 48 hours postoperatively demonstrated excellent hemostasis in both groups. Urinary extravasation was detected in 8 (80%) of 10 animals in the HFSP group and 1 (9%) of 11 in the conventional group at 48 hours (P < 0.008). At the 6-week computed tomography evaluation, none of the animals showed evidence of urinoma or hematoma formation. Histopathologically, at 6 weeks, the cut surface of the kidneys in both groups had been replaced by dense scar tissue at the cortex with a sharp line of demarcation between the scar and normal kidney. CONCLUSIONS: HFSP greatly facilitates laparoscopic heminephrectomy by providing rapid and lasting hemostasis without suturing. Early urine extravasation was more common in the HFSP group, but no clinical, gross, or radiographic evidence of urinoma formation was seen in either group 6 weeks after surgery.

Advanced hemostatic dressing development program: animal model selection criteria and results of a study of nine hemostatic dressings in a model of severe large venous hemorrhage and hepatic injury in Swine.

BACKGROUND: An advanced hemostatic dressing is needed to augment current methods for the control of life-threatening hemorrhage. A systematic approach to the study of dressings is described. We studied the effects of nine hemostatic dressings on blood loss using a model of severe venous hemorrhage and hepatic injury in swine. METHODS: Swine were treated using one of nine hemostatic dressings. Dressings used the following primary active ingredients: microfibrillar collagen, oxidized cellulose, thrombin, fibrinogen, propyl gallate, aluminum sulfate, and fully acetylated poly-N-acetyl glucosamine. Standardized liver injuries were induced, dressings were applied, and resuscitation was initiated. Blood loss, hemostasis, and 60-minute survival were quantified. RESULTS: The American Red Cross hemostatic dressing (fibrinogen and thrombin) reduced (p < 0.01) posttreatment blood loss (366 mL; 95% confidence interval, 175-762 mL) and increased (p < 0.05) the percentage of animals in which hemostasis was attained (73%), compared with gauze controls (2,973 mL; 95% confidence interval, 1,414-6,102 mL and 0%, respectively). No other dressing was effective. The number of vessels lacerated was positively related to pretreatment blood loss and negatively related to hemostasis. CONCLUSION: The hemorrhage model allowed differentiation among topical hemostatic agents for severe hemorrhage. The American Red Cross hemostatic dressing was effective and warrants further development.