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What's New in Shock, Military Supplement September 2016.

In this second Military Supplement to Shock, we again highlight recent Department of Defense (DoD)-funded intramural and extramural research. This issue features 3 review articles (1–3): 1 commentary on national trauma research in the United States (4), 10 clinically oriented studies (5–14), and 10 animal studies (15–24). With much preclinical research suggesting that proestrous female rats have higher survival rates in models of hemorrhagic shock and sepsis, estrogens have shown promise as a potential therapeutic agent in these conditions. In the Defense Advanced Research Projects Agency Surviving Blood Loss Program, estrogen was shown to improve 6-hour survival in a 60% rat hemorrhage model. The review by Weniger et al (1) provides an overview of the current evidence with estrogens and particularly, ethynyl estradiol 3-sulfate and the efforts to move the product into clinical studies. The review by Russo et al (2) focuses on emerging endovascular therapies for non-compressible torso hemorrhage (NCTH) control. When the war in Afghanistan began in 2001, the US military only had standard gauze to use for hemorrhage control. In the past decade and a half, working with several commercial companies, the military has expended much effort to investigate and field new exovascular dressings with hemostatic properties to control compressible hemorrhage. NCTH, however, remains a significant capability gap for both the military and civilian sector. In the past several years, resuscitative balloon occlusion of the aorta (REBOA) has re-emerged as a potential endovascular tool to stem NCTH until the surgeon can get hemorrhage control. REBOA is, however, limited by the physiologic stress of complete occlusion, particularly in the trauma patient. Russo et al (2) highlight endovascular therapies, their complexity and limitations, and the newer efforts to overcome these limitations. The last review, by Kottke and Walters (3) summarizes investigations of mechanisms related to tissue edema. Although edema can be a consequence of illness and disease, the major consequences of edema related to burn and non-burn trauma and subsequent ischemia/reperfusion injury are of most interest. The review discusses many of the studies demonstrating the