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Real-Time In Vivo Measurement of Reactive Oxygen Species: Potential Measure to Mitigate Injury Sequelae of Hemorrhaging Warriors


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Background and Rationale: Future conflicts that occur in anti-access and area denial (A2/AD) environments present unique challenges to prompt and expeditious medical evacuation for casualties. It is anticipated that combat casualty care will be necessary for prolonged periods, likely beyond the golden hour. Hemorrhage, particularly from the torso and junctional regions, are deemed injuries to be potentially survivable.Resuscitative endovascular occlusion of the aorta (REBOA) and tourniquets provide temporary cessation of blood loss and are promising adjuncts in delaying acute mortality due to exsanguination. In austere environments, these hemorrhage control interventions allow for sustained perfusion of vital organs in the event of delayed evacuation. Nevertheless, 60 min is the established maximum for complete thoracic REBOA due to the risk of organ failure from ischemia-reperfusion injury (IRI). The hallmark of IRI is the robust production of reactive oxygen species (ROS) which occurs very early and causes tissue damage. If not immediately addressed, organ failure can ensue which is difficult to correct and has high mortality rates. Rapid and real-time measurement of ROS to assess the progression of IRI is extremely difficult because ROS is highly reactive and short-lived in the patient. evolution by novel tools such as electrochemical biosensors within live tissues will provide real-time indication of IRI. Aims and Study Design: In aim 1, the surface chemistry of the bioreagent will be optimized to enhance the biosensors robustness and to improve its sensitivity and signal-to-noise ratio. The probe will also be miniaturized for field applications. The modified biosensor will be validated using freshly prepared ex vivo rat kidneys subjected to hypoxia-reoxygenation.



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