Page 75 - JSOM Spring 2020

increase in HMGB1 documented in our study adds to the body during PFC and en route care. Rapid point of injury lab-on-a-
of work and collectively justifies its utilization in trauma care. chip assays and anti-HMGB1 therapy are potential diagnostic
Although there is currently insufficient information regarding and treatment modalities that can be useful in the management
the acute clinical implications of increased HMGB1 levels, of patients with chest trauma and ARDS and may enhance the
the increased presence of this marker in systemic blood in our decision-making capability of SOF medics.
study suggests its potential utility as a predictor of multiorgan
failure and death. Not only was the latter directly assessed in Author Contributions
this study, but also future work will interrogate the association All authors participated in study design, protocol writing,
of HMGB1 increases with outcomes and end organ damage. analysis of data and manuscript writing and critical revisions.

To achieve these goals, measurement of HMGB1 and other an- Disclosures/Conflicts of Interest/Funding
alytes in plasma/serum at point of injury will require develop- The opinions or assertions contained herein are the private
ment of new chip-based technology. The current ELISA method views of the authors and are not to be construed as official or
is very well established but would not be feasible in the field. as reflecting the views of the Department of the Army, Depart-
Lateral flow immunochromatographic assay is one promising ment of the Air Force, or the Department of Defense. This study
way to measure bedside markers. However, it may have lim- was funded by the US Air Force and administered through the
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ited accuracy. Nanotechnology-based solutions are being devel- 59th MDW via The Geneva Foundation under Contract No.
oped to measure HMGB1 based on DNA nano- objects binding FA8650-15-C-6692, principal investigator Andriy Batchinsky.
HMGB1, which could soon permit transition to point-of-need The experiments reported herein were conducted according to
measurement. Other microfluidics-based “lab-on-a-chip” the principles set forth in the National Institutes of Health Pub-
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solutions have been developed and may provide a pathway lication No. 80-23, “Guide for the Care and Use of Laboratory
for cellphone-based analysis of injury indices. All of these ap- Animals and the Animal Welfare Act of 1966,” as amended.
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proaches would enhance the SOF medic’s ability to diagnose, The authors report no conflicts of interest.
triage, and intervene in severely injured combat casualties.

We also studied pfHb, which has been identified as an indepen- References
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