Water supply facility damage and water resource operation at disaster base hospitals in miyagi prefecture in the wake of the Great East Japan Earthquake.

INTRODUCTION: The aim of this study was to shed light on damage to water supply facilities and the state of water resource operation at disaster base hospitals in Miyagi Prefecture (Japan) in the wake of the Great East Japan Earthquake (2011), in order to identify issues concerning the operational continuity of hospitals in the event of a disaster. METHODS: In addition to interview and written questionnaire surveys to 14 disaster base hospitals in Miyagi Prefecture, a number of key elements relating to the damage done to water supply facilities and the operation of water resources were identified from the chronological record of events following the Great East Japan Earthquake. RESULTS: Nine of the 14 hospitals experienced cuts to their water supplies, with a median value of three days (range=one to 20 days) for service recovery time. The hospitals that could utilize well water during the time that water supply was interrupted were able to obtain water in quantities similar to their normal volumes. Hospitals that could not use well water during the period of interruption, and hospitals whose water supply facilities were damaged, experienced significant disruption to dialysis, sterilization equipment, meal services, sanitation, and outpatient care services, though the extent of disruption varied considerably among hospitals. None of the hospitals had determined the amount of water used for different purposes during normal service or formulated a plan for allocation of limited water in the event of a disaster. CONCLUSION: The present survey showed that it is possible to minimize the disruption and reduction of hospital functions in the event of a disaster by proper maintenance of water supply facilities and by ensuring alternative water resources, such as well water. It is also clear that it is desirable to conclude water supply agreements and formulate strategic water allocation plans in preparation for the eventuality of a long-term interruption to water services.

Plasma cyclophilin A is a novel biomarker for coronary artery disease.

BACKGROUND: Oxidative stress induces secretion of cyclophilin A (CyPA) from vascular smooth muscle cells and it plays a crucial role in the pathogenesis of atherosclerosis in mice. Therefore, we tested our hypothesis that plasma CyPA levels are increased in patients with coronary artery diseases (CAD). METHODS AND RESULTS: In 320 consecutive patients undergoing coronary angiography, we examined the relationship between plasma CyPA levels and the severity of CAD. We measured plasma CyPA by an immunoassay based on the sandwich technique. Plasma CyPA levels were significantly higher in patients with significant coronary stenosis compared to those without it (P<0.001). A positive correlation was noted between plasma CyPA levels and significant coronary stenosis. The average number of stenotic coronary arteries and the need for coronary intervention were significantly increased in the quartiles of higher CyPA levels (both P<0.001). Indeed, the plasma CyPA level significantly correlated with the presence of CAD (adjusted odds ratio for CAD, 6.20; 95% confidence interval, 3.14-12.27; P<0.001). Interestingly, plasma levels of CyPA increased according to the number of atherosclerotic risk factors, all of which induce oxidative stress. Furthermore, plasma levels of CyPA significantly reduced after medical treatment of risk factors. Finally, CyPA was strongly expressed in coronary atherosclerotic plaque in patients with myocardial infarction. CONCLUSIONS: Plasma CyPA level is a novel biomarker for oxidative stress and CAD in humans.

Validation of mortality risk stratification models for cardiovascular disease.

Risk stratification models are effective tools for the management of cardiovascular diseases. Although several risk scores have been proposed, the relevance and superiority of these predictive models have not been fully validated in an independent and nonclinical trial-based population. We studied 2,472 consecutive patients initially hospitalized in our institution from April 2004 to December 2009. Risk scores were calculated for each patient using 4 risk score models, including the Seattle Heart Failure Model (SHFM), Acute Decompensated Heart Failure National Registry regression model, the American Heart Association Get With The Guidelines-Heart Failure score, and the Association of Health Aging and Body Composition Heart Failure score. The predictive ability for the composite end point, including total death, heart transplantation, and left ventricle assist device implantation, was assessed by calculating the area under the receiver operating characteristic curve for each model. During the follow-up period after admission (median 924.5 days), the combined end point occurred in 295 patients (11.8%), including 27 in-hospital deaths (1.1%). Compared with the other 3 risk score models, the SHFM risk score demonstrated a greater area under the curve for the combined end point at the overall, in-hospital, 30-day, and 1-, 2-, and 3-year follow-up point (0.741 to 0.890). The survival rate predicted by SHFM demonstrated an excellent correlation with the actual survival rate (R(2) = 0.990). In conclusion, these results suggest that the SHFM risk score is the most suitable for the discrimination and calibration of mortality risk stratification in patients with cardiovascular disease.