The Fort Hood Massacre: Lessons learned from a high profile mass casualty.

Background: On November 5, 2009, an army psychiatrist at Fort Hood in Killeen, TX, allegedly opened fire at the largest US military base in the world, killing 13 and wounding 32.

Methods: Data from debriefing sessions, news media, and area hospitals were reviewed.

Results: Ten patients were initially transferred to the regional Level I trauma center.

Phthalate esters used as plasticizers in packed red blood cell storage bags may lead to progressive toxin exposure and the release of pro-inflammatory cytokines.

Phthalate esters (PE's) are plasticizers used to soften PVC-based medical devices. PE's are the most abundant man-made pollutants and increase the risk of developing an allergic respiratory disease or a malignancy. The leaching of PE's in donated packed red blood cells (PRBC) during storage was assessed.

Potential dysregulation of the pyruvate dehydrogenase complex by bacterial toxins and insulin.

Background: The pyruvate dehydrogenase complex (PDC) catalyzes the conversion of pyruvate to acetyl CoA, effectively controlling the entrance of glycolysis products into aerobic metabolism. Because hyperlactatemia is one of the hallmarks of sepsis, we hyphothesized that gram-positive and negative bacterial toxin treatment will interfere with mRNA levels of regulatory enzymes of the PDC and overall enzyme activity in hepatocytes.

Methods: HEP G2 hepatocarcinoma cells were incubated for 24 hours in the presence of lipopolysaccaride (LPS) or lipoteichoic acid.

Effects of a nonsurgical hospitalist service on trauma patient outcomes.

Background: The American College of Surgeons criteria for Level I trauma centers calls for >90% of trauma patients to be admitted directly by a trauma surgeon or surgical subspecialist; however, the efficiency of the trauma system may be increased if patients presenting with comorbid conditions and minor injuries are treated by a hospitalist team (nonsurgical Trauma MEDical [TMED] service). We hypothesized outcomes would be equivalent for patients treated under TMED versus a surgical service.

Methods: This retrospective review compared mortality, hospital length of stay (LOS), Emergency Department (ED) LOS, placement to rehabilitation facilities, and complication rates for patients who could have been treated by TMED as identified by an algorithm.

Mechanisms of delayed wound healing by commonly used antiseptics.

Background: The cytotoxic effects of antiseptics on pivotal cell types of the healing process have been well documented. The purpose of our investigation was to explore the ability of subcytotoxic levels of antiseptics to interfere with fibroblast function.

Methods: Cell proliferation assays were performed by culturing fibroblasts in the presence of commonly used antiseptics.

The effect of storage on the accumulation of oxidative biomarkers in donated packed red blood cells.

Background: Transfusion-related acute lung injury (TRALI) is a life-threatening condition characterized by oxidative stress. Longer storage times of packed red blood cells (PRBC) and other blood products have been implicated with an increased risk in developing TRALI in transfused patients.

Methods: A total of 10 units of blood containing PRBC stored in citrate-phosphate-dextrose buffer at 4 degrees C were included in the study.

Reduced mortality at a community hospital trauma center: the impact of changing trauma level designation From II to I.

Objective: To determine if a change in trauma designation from level II (L2) to level I (L1) in the same institution reduces mortality.

Design, Setting, And Patients: A retrospective cohort study of all patients consecutively admitted to a community hospital trauma center.

Intervention: The upgrade to trauma L1 designation (January 1, 2003-March 31, 2007) (n = 7902) from trauma L2 designation (January 1, 1998-December 31, 2002) (n = 9511).

Clinical utility of the cobalt-albumin binding assay in the diagnosis of intestinal ischemia.

Currently, the rapid diagnosis of mesenteric ischemia is problematic because of the nonspecificity of most laboratory assays and the unreliability of physical examinations. The evaluation of the cobalt-albumin binding assay (CABA) as a diagnostic marker for short-term risk stratification of emergency department patients presenting with symptoms of intestinal ischemia is reported. This preliminary study includes patients scheduled for exploratory laparotomy with symptoms of ischemic bowel and/or bowel obstruction.

A diketopiperazine fragment of human serum albumin modulates T-lymphocyte cytokine production through rap1.

Background: Aspartyl-alanyl- diketopiperazine (DA-DKP) is generated by cleavage and cyclization from the N-terminus of human albumin during the preparation of commercial serum albumin product. Antigen-stimulated human T lymphocytes produce significantly lower quantities of interferon-gamma and tumor necrosis factor-alpha after stimulation in vitro in the presence of DA-DKP.

Methods: T lymphocytes activated in the presence of DA-DKP were analyzed by pull-down western blot assay for the activation of the guanosine triphosphatase Rap1 and by quantitative immunoassay for the phosphorylated transcription factors ATF-2 (activating transcription factor-2) and c-jun, which regulate the production of interferon-gamma and tumor necrosis factor-alpha.

Mass spectrometry analysis of urine and catheter of a patient with purple urinary bag syndrome.

Introduction: Purple urinary bag syndrome (PUBS) is considered to be a benign condition observed in the urinary catheter and bag in some catheterized patients with urinary tract infections. This syndrome is usually reported to occur in alkaline urine.

Case Report: We report of a catheterized patient with PUBS and slightly acidic urine (pH 6-6.

The role of disease burden measures in future estimates of endemic waterborne disease.

The 1996 Safe Drinking Water Act amendments require the US Environmental Protection Agency and the Centers for Disease Control and Prevention to develop a national estimate of the occurrence of waterborne infectious disease that is attributable to public drinking water systems in the United States. Much of the information for developing the national estimate will be derived from epidemiologic data, and the primary outcome of this effort will be an estimate of the number of cases of gastrointestinal illness. While quantifying the number of these cases provides some measure of waterborne disease impact, the usefulness of this measure may be limited because the full spectrum of societal impact also involves consideration of the additional effects of these diseases such as hospitalization costs and lost productivity.

Waterborne outbreaks reported in the United States.

Epidemic waterborne risks are discussed in this paper. Although the true incidence of waterborne illness is not reflected in the currently reported outbreak statistics, outbreak surveillance has provided information about the important waterborne pathogens, relative degrees of risk associated with water sources and treatment processes, and adequacy of regulations. Pathogens and water system deficiencies that are identified in outbreaks may also be important causes of endemic waterborne illness.

Severe systemic immune response syndrome, low plasma paraoxonase activity, and a new albumin species in a traumatized patient with Gaucher's disease.

Introduction: Gaucher's disease (GD) is an inborn error, autosomal recessive lysosomal lipid storage disorder characterized by the lack of the enzyme glucocerebrosidase. We observed some abnormalities in the plasma of a traumatized patient with GD.

Case Report: We report of a traumatized patient with GD that developed a severe systemic immune response during the course of an extended hospital stay.

The formation and rapid clearance of a truncated albumin species in a critically ill patient.

Introduction: Hypoalbuminemia is known to occur in critically ill patients and is associated with increased mortality. We observed a potentially novel, partial explanation for the hypoalbuminemia noticed in a severely traumatized patient.

Case Report: We report of a severely, multi-system traumatized patient in whom hypoalbuminemia was present (1-2 g/dl).

Outbreaks associated with recreational water in the United States.

In this article, we review the causes of outbreaks associated with recreational water during 1971-2000. A bacterial or protozoan etiology was identified in three-quarters of the outbreaks; 23% of the outbreaks were of undetermined etiology. The most frequently identified agents were Cryptosporidium (15%), Pseudomonas (14%), Shigella (13%), Naegleria (11%), Giardia (6%), and toxigenic E.

Heterogeneity and oxidation status of commercial human albumin preparations in clinical use.

Objective: Human serum albumin is indicated for the treatment of shock, acute restoration of blood volume, and in hypoalbuminemia. Conflicting reports are found in the literature for the clinical safety and efficacy of human serum albumin administration to critically ill patients. We sought to analyze various commercially available albumin preparations for common, posttranslational modifications.

The association between Chance fractures and intra-abdominal injuries revisited: a multicenter review.

The association between Chance fractures and intra-abdominal injuries is reported to be as high as 89 per cent. Because prior studies were small series or case reports, we conducted a multicenter review to learn the true association between Chance fractures and intra-abdominal injuries as well as diagnostic trends. Trauma registry data, medical records, and radiology reports from 7 trauma centers were used to characterize 79 trauma patients with Chance fractures.

Interleukin-16 expression in the peripheral blood and CD8 T lymphocytes after traumatic injury.

Background: Expressed in several pathologic conditions, interleukin (IL-16) can induce chemotaxis and regulate the activation of CD4-positive leukocytes. This study investigated the expression of IL-16 in trauma patient plasma and peripheral blood leukocytes to determine its involvement in the physiologic response to injury.

Methods: In this study, 25 consecutive patients requiring trauma team activation and 15 noninjured subjects were evaluated for plasma IL-16 by enzyme-linked immunosorbent assay and peripheral blood leukocyte expression of intracellular cytokine by flow cytometry.

Lipid peroxidation and the thiobarbituric acid assay: standardization of the assay when using saturated and unsaturated fatty acids.

Saturated fatty acids are less vulnerable to lipid peroxidation than their unsaturated counterparts. In this investigation, individual fatty acids of the C(16), C(18) and (20) families were subjected to the thiobarbituric (TBA) assay. These fatty acids were chosen based on their degree of saturation and configuration of double bonds.

Plasma albumin cysteinylation is regulated by cystathionine beta-synthase.

High homocysteine (Hcy) levels are a well-known independent risk factor for endothelial damage in atherosclerosis. We examined whether a rat intestinal model of ischemia-reperfusion was associated with high Hcy and with the modification of plasma albumin into cysteinylated species (CysAlb). The three treatment groups were as follows: midline abdominal incision (group A, n=10), followed by ligation of the superior mesenteric artery for a period of 2h (group B, n=3), and followed by reperfusion for 1h (group C, n=10).

An anti-inflammatory role for N-acetyl aspartate in stimulated human astroglial cells.

Although N-acetyl-L-aspartate (NAA) has been shown to be important to myelin synthesis and osmotic regulation, the biological rationale for the high levels of NAA found in the brain remains unknown. Here, a human astroglial cell line (STTG) was treated with NAA and stimulated with ionomycin, ionomycin/PMA, or IL-1beta. PGE(2) levels in ionomycin-stimulated STTG cells decreased by 76% and > 95% at NAA concentrations of 10 and 20mM, respectively.

Outbreaks in drinking-water systems, 1991-1998.

During 1991-1998, 126 outbreaks, 429,021 cases of illness, 653 hospitalizations, and 58 deaths were reported in public and individual water systems in 41 states and three U.S. territories.