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Madigan Research Day

A peek at the future of medicine

Madigan Public Affairs

Published: 03:19PM May 11th, 2017

Whether they were potentially life-saving new methods for opening airways or effectively placing tourniquets, or searching for ways to prevent cerebral palsy or to avoid surgery complications, the best Madigan Army Medical Center research projects got some time in the spotlight as residents, fellows and staff members presented research findings to their peers and other medical experts at Madigan Research Day April 28.

Although only 18 research projects were presented at the event, more than 100 were submitted for consideration and 50 projects were highlighted as poster displays.

“Madigan Research Day is our one day that we really focus on and showcase the high-impact research that is occurring here at Madigan,” said Col. (Dr.) Richard Burney, chief of Madigan’s Department of Clinical Investigation.

One of the presenters hopes her work will help contribute to the prevention of cerebral palsy.

“We are studying how does preterm labor affect the brain,” said Maj. Sarah Estrada, a maternal fetal medicine fellow at Madigan. “That’s important because preterm babies are much more likely to go on to develop cerebral palsy, which is a lifelong, neuro-developmental disease that affects not only the patient but the families and the people surrounding that individual.”

Estrada’s research is part of multiyear effort to discover what might contribute to the development of cerebral palsy and to then find out how to prevent it. The research team previously found that the gene called Nur 77 is involved in inflammation that occurs with preterm delivery and often results in brain injury. While the gene is not normally present, their team discovered that it is activated with preterm delivery. Estrada delved deeper into why Nur 77 was turned on and discovered that this gene is required for the full spectrum of brain inflammation to occur.

Next up is not only more research to prevent the disease, but also participation in a separate project that looks at adult implications of preterm labor to include if adults are more susceptible to dementia or Alzheimer’s, or even to traumatic brain injuries.

Like Estrada’s work, military medicine research can contribute to advancing health care in general or zero in more specifically on addressing the needs of service members downrange.

“There are some projects that literally have the potential to change field manuals,” Burney said.

That includes work aimed at directly saving lives on the battlefield, such as assistance in placing tourniquets.

“The big issue with tourniquets is that people have a hard time placing them, that’s something that requires a lot of training. Sometimes even when you do get it to be placed right, they can subsequently release,” said Capt. Morgan Barron, a Madigan general surgery resident. “People are dying from it — Soldiers are dying from it.”

Although there are no current monitoring devices being used on the battlefield to gauge the effectiveness of tourniquets, Barron and his fellow researchers are studying whether thermal imaging cameras connected to smartphones can do so.

“The real surprising thing about this was the thermal imaging camera was reliable. You could see this decrease in temperature over time, and the decrease in temperature was staggeringly different between an adequately placed tourniquet and an inadequately placed tourniquet,” Barron said. “If there was any blood flow going past that tourniquet, then there was no temperature change.”

Better yet, the thermal images were easy to interpret. Barron showed thermal images of tourniquets correctly applied versus tourniquets poorly (and ineffectively) placed; the residents who participated in the study correctly read the images greater than 95 percent of the time.

Given the methodical and rigorous demands of medical research, it could take years more to prove that the devices would be effective on the battlefield. Still, this is the hope that drives Barron on in his studies — the idea that medics on the battlefield could someday use the results of this research to save service members.

“If you were able to have a medic on a medevac flight, just take a little camera out and start looking at people’s legs, and say, ‘This guy is probably rebleeding; let me retighten that tourniquet,’ (then) you could save a life,” he said.