Divergent effect of mammalian PLCζ in generating Ca²âº oscillations in somatic cells compared with eggs.

Sperm PLCζ (phospholipase Cζ) is a distinct phosphoinositide-specific PLC isoform that is proposed to be the physiological trigger of egg activation and embryo development at mammalian fertilization. Recombinant PLCζ has the ability to trigger Ca²âº oscillations when expressed in eggs, but it is not known how PLCζ activity is regulated in sperm or eggs. In the present study, we have transfected CHO (Chinese-hamster ovary) cells with PLCζ fused with either YFP (yellow fluorescent protein) or luciferase and found that PLCζ-transfected cells did not display cytoplasmic Ca²âº oscillations any differently from control cells. PLCζ expression was not associated with changes in CHO cell resting Ca²âº levels, nor with a significantly changed Ca²âº response to extracellular ATP compared with control cells transfected with either YFP alone, a catalytically inactive PLCζ or luciferase alone. Sperm extracts containing PLCζ also failed to cause Ca²âº oscillations in CHO cells. Despite these findings, PLCζ-transfected CHO cell extracts exhibited high recombinant protein expression and PLC activity. Furthermore, either PLCζ-transfected CHO cells or derived cell extracts could specifically cause cytoplasmic Ca²âº oscillations when microinjected into mouse eggs. These data suggest that PLCζ-mediated Ca²âº oscillations may require specific factors that are only present within the egg cytoplasm or be inhibited by factors present only in somatic cell lines.

Be vigilant for secondary periprosthetic joint infection.

Periprosthetic joint infection (PJI) is caused by haematogenous spread from a distant primary infection in 70% of deep infections. It can potentially be avoided by prompt recognition and treatment of the primary infection focus in susceptible patients. Streptococci are commonly implicated in such secondary infections. Group A, B, C and G streptococci can cause invasive, potentially life-threatening infection. Risk factors include diabetes, immunodeficiency and venous insufficiency Any patient with a joint replacement should be counselled to seek early attention for any soft tissue or dental infection. A course of antibiotics should be considered in any wound in which there has been significant contamination. Patients at risk of infection through impaired physical defences such as chronic venous insufficiency should be treated appropriately and consideration should be given to prophylactic treatment of varicose veins if there are early signs of chronic venous insufficiency. Mild, uncomplicated cellulitis can be treated with oral antibiotics, simple penicillin agents such as amoxicillin or flucloxacillin should be administered. Patients should be referred to hospital for consideration of parenteral antibiotics if they are exhibiting signs of systemic sepsis such as tachycardia, pyrexia or hypotension. PJI should be suspected if a patient with a joint replacement develops pain in that joint after a soft tissue, respiratory tract or dental infection. In cases of suspected PJI prompt orthopaedic advice should be sought and antibiotics withheld.

Protecting home health care workers: a challenge to pandemic influenza preparedness planning.

The home health care sector is a critical element in a pandemic influenza emergency response. Roughly 85% of the 1.5 million workers delivering in-home care to 7.6 million clients are low-wage paraprofessionals, mostly women, and disproportionately members of racial and ethnic minorities. Home health care workers' ability and willingness to respond during a pandemic depends on appropriate communication, training, and adequate protections, including influenza vaccination and respiratory protection. Preparedness planning should also include support for child care and transportation and help home health care workers protect their income and access to health care. We summarize findings from a national stakeholder meeting, which highlighted the need to integrate home health care employers, workers, community advocates, and labor unions into the planning process.

Use of "shuttered" hospitals to expand surge capacity.

INTRODUCTION: With limited available hospital beds in most urban areas, there are very few options when trying to relocate patients already within the hospital to make room for incoming patients from a mass-casualty incident (MCI) or epidemic (a patient surge). This study investigates the possibility and process for utilizing shuttered (closed or former) hospitals to accept medically stable, ambulatory patients transferred from a tertiary medical facility. METHODS: Two recently closed, acute care hospitals were evaluated critically to determine if they could be made ready to accept inpatients within 3-7 days of a MCI. This surge facility ideally would be able to support 200-300 patients/beds. Two generic scenarios were used for planning: (1) a patient surge (including one caused by conventional war or terrorism, weapons of mass destruction, or a disaster caused by natural hazards) requiring transfer of ambulatory, medically-stable inpatients to another facility in an effort to increase capacity at existing hospitals; and (2) a bio-event or epidemic where a shuttered hospital could be used as an isolation facility. RESULTS: Both recently closed hospitals had significant, but different challenges to reopening, although with careful planning and resource allocation it would be possible to reopen them within 3-7 days. Planning was the most conclusive recommendation. It does not appear possible to reopen shuttered hospitals with major structural deterioration or a complete lack of current mission (i.e., no current utilities). Staffing would represent the most challenging issue as a surge facility would represent an incremental additional need for existing and scarce human resources. CONCLUSIONS: With careful planning, a shuttered hospital could be reopened and ready to accept patients within 3-7 days of a MCI or epidemic.

Hyperalgesia following ischaemia of the rat's tail.

We have investigated the effects of ischaemia on responses to a subsequent noxious stimulus in rats. Tail flick latencies to a noxious thermal stimulus were determined by immersing the tail in water at temperatures ranging from 39 to 49 degrees C. We then produced ischaemia by occluding the blood supply to the tail; ischaemia was terminated at the first signs of an escape response. Tail flick latencies were recorded immediately after termination of ischaemia and at 30 min intervals for another 2 h. Each rat acted as its own control. Tail flick latency decreased after ischaemia; we found a decrease of about 39% immediately after ischaemia, at immersion temperatures above 39 degrees C. The duration of the hyperalgesia increased with increasing water temperatures. Thus noxious ischaemia of the rat tail induced hyperalgesia to subsequent noxious thermal stimuli. The hyperalgesia could have arisen through either central or peripheral mechanisms.

Injectable aspirin and mepyramine abolish post-ischaemic hyperalgesia in rats.

We have investigated the effects of mepyramine, an H1 receptor antagonist, and lysine acetylsalicylate, a cyclo-oxygenase inhibitor, on post-ischaemic hyperalgesia in rats. We induced tail ischaemia in conscious rats by applying a tourniquet until the rats exhibited coordinated escape behaviour, when we released the tourniquet. We assessed hyperalgesia, by measuring tail flick latency following tail immersion in water at 49 degrees C, immediately after releasing the tourniquet and then at 30 min intervals for 2 h. After pretreatment with the drug vehicles, tail flick latency decreased significantly following ischaemia. Pretreatment with mepyramine maleate (3 mg/kg), or lysine acetylsalicylate (400 mg/kg), injected subcutaneously, abolished the decrease. We conclude that both histamine release and prostanoid synthesis are involved in the post-ischaemic hyperalgesia.

Deep infection after hip fracture surgery: predictors of early mortality.

INTRODUCTION: This study analysed the predictors of mortality in patients who are diagnosed with deep infection following hip fracture surgery. METHODS: Data were prospectively collected for 3 years from all patients undergoing hip fracture surgery and who had developed a subsequent deep infection. Infection was defined as positive microbiology culture from deep tissue or fluid samples. Demographic data, treatment, complications and subsequent surgeries were analysed. Potential predisposing factors including chronic medical co-morbidities, American Society of Anesthesiologists (ASA) grade, alcohol excess and smoking were assessed. The main outcome measures were 30-day and 1-year mortality. RESULTS: There were 2718 consecutive operations performed for a fracture of the proximal femur over a 3-year period. Forty-three (1.6%) patients had a deep postoperative infection diagnosed on fluid and/or tissue sampling. The mean age was 73 years (25-94) and 65% were female. Of the 43 patients who developed deep infection, the primary procedure in 25 (58%) patients was reduction and internal fixation, with 18 (42%) undergoing hemi-arthroplasty. The most common causative organism was Staphylococcus epidermidis (n=13, 30%), with methicillin-resistant Staphylococcus aureus (MRSA) accounting for 23% (n=10). The 30-day mortality was significantly higher than that of patients with no deep infection (19% vs. 6.5%; p=0.004). On univariate analysis, increasing age, dementia and diabetes were predictive of both 30-day and 1-year mortality (all p<0.05). S. aureus (sensitive or resistant) was approaching significance at 1 year (p=0.065). On multivariate analysis, dementia and diabetes were independent predictors of 30-day mortality, with dementia and S. aureus predictive at 1 year. CONCLUSIONS: The 30-day mortality rate in patients diagnosed with deep infection following hip fracture surgery is higher than those without infection. Dementia, diabetes and S. aureus infection are independent predictors of mortality following deep infection.

The Plate-Joystick technique to reduce proximal humeral fractures and nonunions with a varus deformity through the extended deltoid-splitting approach.

Fractures and nonunions in which there is a varus deformity of the humeral head producing posterinferior subluxation of the articular surface are increasingly recognized as an important subgroup of proximal humeral fractures. Operative open reduction and internal fixation of these injuries is often recommended when the varus deformity is severe. We describe a simple technique to assist in the open reduction and locking plate stabilization of this challenging and complex fracture subtype using tools and implants that are readily available in most modern orthopaedic trauma operating rooms.

A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting.

Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION), posterior ischaemic optic neuropathy (PION), and central retinal artery occlusion (CRAO). These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass); general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone), alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.

The Edinburgh variant of a talar body fracture: a case report.

We describe a novel closed pantalar dislocation with an associated sagittal medial talar body and medial malleolus fractures. Closed reduction was attempted unsuccessfully. Open reduction was performed, revealing a disrupted talonavicular joint with instability of the calcaneocuboid joint. This configuration required stabilisation with an external fixator. There were no signs of avascular necrosis, or arthrosis at 15 months follow but is currently using a stick to mobilise.

Palliative care considerations in mass casualty events with scarce resources.

Catastrophic mass casualty events, such as pandemic flu outbreaks or large-scale terrorism-related events, could yield thousands of victims whose needs would overwhelm local and regional healthcare systems, personnel, and resources. Such conditions will require deploying scarce resources in a manner that is different from the more common single-event disaster. This article introduces the topic of palliative care during a mass casualty event and reviews the major findings for a federally funded planning guide that examined palliative care issues associated with providing medical care under circumstances where resources are scarce. We focus on the role of palliative care in the support of individuals not expected to survive and offer recommendations of specific actions for a coordinated disaster response plan. Semistructured telephone discussions with disaster management experts and a group meeting of experts identified issues, roles, responsibilities, procedures, and resources that offer the benefits of integrating palliative care into disaster planning and response. The investigations identified 5 domains of concern, along with guidance: (1) the role of palliative care in a mass casualty event with resulting scarce resources; (2) the triage and ensuing treatment decisions for those "likely to die"; (3) the critical palliative care services to provide, along with the personnel and settings; (4) the pragmatic plans needed for ensuring training, supplies, and organizational or jurisdictional arrangements; and (5) unusual issues affecting palliative care under mass casualty event scenarios. Palliative care minimizes the suffering of those who die, ensures comfort, addresses their needs, and may also free up resources to optimize survival of others. Planning to provide palliative care during mass casualty events should be part of the current state and local disaster planning/training guidelines, protocols, and activities.

Management of a catheter-induced pulmonary artery rupture: early presentation after off-pump coronary artery bypass surgery.

A frail, 79-year-old woman with small body habitus was admitted for elective coronary artery bypass surgery. She was known to have long-standing chronic stable angina with recent deterioration. Her only risk factor for coronary artery disease was that she was an ex-smoker of 6 years.

Current status of surge research.

The dramatic escalation of bioterrorism and public health emergencies in the United States in recent years unfortunately has coincided with an equally dramatic decline in the institutions and services we rely on for emergency preparedness. Hospitals in nearly every metropolitan area in the country have closed; those that remain open have reduced the number of available beds. "Just in time" supplies and health professional shortages have further compromised the nation's overall surge capacity. Emergency departments routinely operate at capacity. These circumstances make evidence-based research on emergency preparedness and surge capacity both more urgently needed and more complex. The Agency for Healthcare Research and Quality and other government and private agencies have been rapidly widening the field of knowledge in this area in recent months and years. This report focuses primarily on the work of the Agency for Healthcare Research and Quality.