Tracking the daily availability of burn beds for national emergencies

Medical planning for Operation Iraqi Freedom included predictive models of expected number of burn casualties. In all but the best-case scenario, casualty estimates exceeded the capacity of the only Department of Defense burn center. Examination of existing federal-civilian disaster plans for military hospital augmentation revealed that bed availability data were neither timely nor accurate. Recognizing the need for accurate knowledge of burn bed availability, the Department of Defense requested assistance from the American Burn Association (ABA). Directors of burn centers in the United States were queried for interest in participation in a mass casualty plan to provide overflow burn bed capacity. A list of 70 participating burn centers was devised based upon proximity to planned military embarkation points. A computer tracking program was developed. Daily automated e-mail messages requesting bed status were sent to burn center directors at 6 am Central time with responses requested before 11 am. The collated list of national overflow burn bed capacity was e-mailed each day to the ABA Central Office and to federal and military agencies involved with burn patient triage and transportation. Once automated, this task required only 1-2 hours a day. Available burn-bed lists were generated daily between March 17 and May 2, 2003 and then every other day until May 9, 2003. A total of 2151 responses were received (mean, 43 burn centers per day). A system to track daily nationwide burn bed availability was successfully implemented. Although intended for military conflict, this system is equally applicable to civilian mass casualty situations. We advocate adoption of this or a similar bed tracking system by the ABA for use during burn mass casualty incidents.     

Could a high-fat diet rich in unsaturated fatty acids impair the cardiovascular system?

BACKGROUND:

Dyslipidemia results from consumption of a diet rich in saturated fatty acids and is usually associated with cardiovascular disease. A diet rich in unsaturated fatty acids is usually associated with improved cardiovascular condition.

OBJECTIVE:

To investigate whether a high-fat diet rich in unsaturated fatty acids (U-HFD) – in which fatty acid represents approximately 45% of the total calories – impairs the cardiovascular system.

METHODS:

Male, 30-day-old Wistar rats were fed a standard (control) diet or a U-HFD containing 83% unsaturated fatty acid for 19 weeks. The in vivo electrocardiogram, the spectral analysis of heart rate variability, and the vascular reactivity responses to phenylephrine, acetylcholine, noradrenaline and prazosin in aortic ring preparations were analyzed to assess the cardiovascular parameters.

RESULTS:

After 19 weeks, the U-HFD rats had increased total body fat, baseline glucose levels and feed efficiency compared with control rats. However, the final body weight, systolic blood pressure, area under the curve for glucose, calorie intake and heart weight/final body weight ratio were similar between the groups. In addition, both groups demonstrated no alteration in the electrocardiogram or cardiac sympathetic parameters. There was no difference in the responses to acetylcholine or the maximal contractile response of the thoracic aorta to phenylephrine between groups, but the concentration necessary to produce 50% of maximal response showed a decrease in the sensitivity to phenylephrine in U-HFD rats. The cumulative concentration-effect curve for noradrenaline in the presence of prazosin was shifted similarly in both groups.

CONCLUSIONS:

The present work shows that U-HFD did not impair the cardiovascular parameters analyzed.     

Overexpression of the cholesterol-binding protein MLN64 induces liver damage in the mouse

AIM: To examine the in vivo phenotype associated with hepatic metastatic lymph node 64 (MLN64) over-expression. METHODS: Recombinant-adenovirus-mediated MLN64 gene transfer was used to overexpress MLN64 in the livers of C57BL/6 mice. We measured the effects of MLN64 overexpression on hepatic cholesterol content, bile flow, biliary lipid secretion and apoptosis markers. For in vitro studies cultured CHO cells with transient MLN64 overexpression were utilized and apoptosis by TUNEL assay was measured. RESULTS: Livers from Ad.MLN64-infected mice exhibited early onset of liver damage and apoptosis. This response correlated with increases in liver cholesterol content and biliary bile acid concentration, and impaired bile flow. We investigated whether liver MLN64 expression could be modulated in a murine model of hepatic injury. We found increased hepatic MLN64 mRNA and protein levels in mice with chenodeoxycholic acid-induced liver damage. In addition, cultured CHO cells with transient MLN64 overexpression showed increased apoptosis. CONCLUSION: In summary, hepatic MLN64 over- expression induced damage and apoptosis in murinelivers and altered cholesterol metabolism. Further studies are required to elucidate the relevance of these fi ndings under physiologic and disease conditions.     

Isolated noncompaction of the myocardium

Noncompaction of the myocardium (NCM) is a rare congenital heart defect. It was first described 15 years ago, and few cases are published. The purpose of this study is to describe a NCM case. Clinical findings and imaging test results of a 37-year-old female patient with isolated NCM are presented. The patient complained of palpitations; her physical examination revealed extrasystoles, and her 12-lead electrocardiogram showed ventricular bigeminy. Three-dimensional Doppler echocardiography revealed numerous prominent trabeculations with deep intertrabecular recesses with blood flow which communicated with the ventricular cavity, which were more intense in the septal apical region. Cardiac magnetic resonance imaging corroborated the echocardiographic findings. The clinical presentation and the patients laboratory test results confirmed the diagnosis of isolated NCM. The knowledge of the echocardiographic findings of this disease enables an early diagnosis and a more adequate treatment.