Sun heated surfaces are an environmental hazard for young children

AIMS

Children commonly sustain heat contact type burn injuries from sun heated surfaces during the summer months in hot, sunny climates. The aim of this study was to review the causes and outcomes in a series of heat contact type burns sustained by children who touched hot sun heated surfaces.

METHODS

A retrospective chart review was performed to identify all children who sustained burn injuries due to naturally heated surfaces and were treated between January 2012 and December 2017 at Children's Hospital Colorado. Demographics of the subjects and clinical data regarding their burn injuries were collected.

RESULTS

A total of 58 children were identified over the study period, involving 118 burn wounds. The median age was 17 months (interquartile range = 14-23), and 33 were male (57%). Mean total body surface area (TBSA) was 1.4% (standard deviation = 1). A foot was the most commonly involved area, affecting 36 subjects (62%). The most common causes of these burn injuries were metal thresholds (n = 7, 12%) and metal covers or lids (n = 5, 9%) outside the home. The depth of the burn injury was partial thickness in 57 children (98%). The mean time to heal was 12 ± 6 days, and the majority of injuries occurred in June (n = 28, 48%).

CONCLUSION

Heat contact type burn injuries from sun heated surfaces commonly affect children ⩽2 years of age during the summer months, and the majority of these injuries occur around the home environment. They are preventable injuries, and this information should be used for prevention and education materials for parents and healthcare providers, who reside in hot, sunny climates.

Gravitational Reflux Does Not Correlate with Clinical Status of Venous Stasis

Objective:

To quantify venous reflux by a standard duplex ultrasound technique and correlate the data obtained with clinical grades of severity of venous disease.

Design:

A prospective study in a single group of patients with venous insufficiency.

Setting:

Private practice in secondary and tertiary care.

Patients:

133 inpatients undergoing investigation for venous disease. Patients with known venous obstruction, arterio-venous malformations or lymphoedema were excluded from the study.

Main outcome measures:

Duplex ultrasound scanning was performed to measure the cross-sectional area, severity and duration of venous reflux following calf compression using a standardized technique.

Results:

Clinical classification assigned to each limb correlated with the presence of venous reflux, but not the quantity, velocity or duration of reflux in the veins studied. Presence of reflux and diameter of the vein studied correlated ( p<0.001) in all the veins except the popliteal vein ( p > 0.03).

Conclusion:

Quantification of venous reflux obtained by cuff deflation does not correlate with clinical severity of venous stasis, but does detect reflux accurately. This allowed greater saphenous sparing in nine limbs in 41 patients but proved the need for saphenous removal in seven limbs not previously suspected clinically of requiring this procedure.

Complications in tunneled CVL versus PICC lines in very low birth weight infants

OBJECTIVE

Comparison of complications associated with tunneled central venous lines (TCVLs) versus peripherally inserted central catheters (PICCs) in infants <1500 g.

STUDY DESIGN

A retrospective cohort study at a university medical center. A total of 96 catheters were placed in 60 infants between 4/94 and 3/99. A retrospective review of these infants' medical record was done to review associated complications of catheter placement.

RESULTS

Both groups had similar weights and gestational ages. The duration of catheterization was 28 days in TCVLs and 11 days in PICCs (p<0.05). Total, infectious, and mechanical complications between the two groups were similar. Survival function estimates showed no difference between the two groups up to the 15th day of catheterization.

CONCLUSION

There is no difference in efficacy or associated complications between the two groups. If one could anticipate needing a catheter longer than 15 days, then a TCVL might be the better choice.

The assembly of immunoglobulin-like modules in titin: implications for muscle elasticity

Titin, a giant muscle protein, forms filaments that span half of the sarcomere and cover, along their length, quite diversified functions. The region of titin located in the sarcomere I-band is believed to play a major rôle in extensibility and passive elasticity of muscle. In the I-band, the titin sequence contains tandem immunoglobulin-like (Ig) modules intercalated by a potentially non-globular region. By a combined approach making use of small angle X-ray scattering and nuclear magnetic resonance techniques, we have addressed the questions of what are the average mutual orientation of poly-Igs and the degree of flexibility around the domain interfaces. Various recombinant fragments containing one, two and four titin I-band tandem domains were analysed. The small-angle scattering data provide a picture of the domains in a mostly extended configuration with their long axes aligned head-to-tail. There is a small degree of bending and twisting of the modules with respect to each other that results in an overall shortening in their maximum linear dimension compared with that expected for the fully extended, linear configurations. This shortening is greatest for the four module construct ( approximately 15%). 15N NMR relaxation studies of one and two-domain constructs show that the motions around the interdomain connecting regions are restricted, suggesting that titin behaves as a row of beads connected by rigid hinges. The length of the residues in the interface seems to be the major determinant of the degree of flexibility. Possible implications of our results for the structure and function of titin in muscles are discussed.

9-Nitrocamptothecin inhibits tumor recrosis factor-mediated activation of human immunodeficiency virus type 1 and enhances apoptosis in a latently infected T cell clone

Transition from latency to active replication is a crucial stage for the process of human immunodeficiency virus type 1 (HIV-1) infection and life cycle. HIV-1 replication in latently infected cells can be strongly induced by the cytokine tumor necrosis factor alpha (TNF-alpha) and the proliferation-arresting chemical sodium butyrate (NaB). We have investigated the ability of the drug 9-nitrocamptothecin (9NC), a potent cellular topoisomerase I (topo I) inhibitor currently in clinical trials in cancer patients, to regulate HIV-1 replication in latently infected lymphocytic ACH-2 cells on reactivation with either TNF-alpha or NaB. Treatment of ACH-2 cells with 9NC alone resulted in increased levels of viral transcripts, while there was a slight reduction or no change in the levels of host cell transcripts. However, pretreatment of ACH-2 cells with 9NC inhibited TNF-alpha-induced extracellular HIV-1 p24 levels up to approximately 95% and nearly 80% of the cell-associated viral RNAs. The quantitative decrease in viral products was concomitant with a decrease in cellular gene expression and induction of apoptosis in the host cells. 9NC blocked the infected cells at the boundary of the S and G2 phases, resulting in an accelerated apoptosis that was further enhanced with TNF-alpha treatment. Similar results were observed following concurrent exposure to TNF-alpha and 9NC, but 9NC failed to inhibit upregulation of HIV-1 mRNA in ACH-2 cells exposed to TNF-alpha before 9NC treatment. Further, 9NC had no inhibitory effect on NaB-induced apoptosis and upregulation of HIV-1 mRNA expression regardless of whether 9NC and NaB were used concurrently or in various treatment sequences. In uninfected lymphocytic CEM cells derived from a common parental cell line, a slight downregulation of cellular gene expression was detected along with low-level apoptosis. These results demonstrate that 9NC impairs TNF-alpha-induced, but not NaB-induced, HIV-1 activation, and suggest a means of inhibiting active HIV-1 viremia arising as a result of elevated TNF-alpha levels.

Aortoenteric fistula. A 7 year urban experience

In this 7 year review of the operative records of a single city's teaching hospitals, we found 28 patients with aortoenteric fistulas. Among 25 patients with secondary aortoenteric fistulas, 80 percent presented with a herald bleed. Sepsis was rare. Most diagnostic maneuvers, with the possible exception of upper gastrointestinal tract endoscopy, computerized axial tomography, or ultrasonography, were unhelpful. As noted by others, graft excision, aortic ligature, and extraanatomic bypass is the only predictably useful operative therapy. Initial hospital survival was 60 percent, but this decreased to 36 percent because recurrent aortic complications developed in more than half the initial survivors, 75 percent of whom died. Although the pathogenesis of aortoenteric fistulas remains obscure, our study demonstrates that patients who have previously undergone complicated, repeated, or emergency aortic operations, including previous repair of an aortoenteric fistula, are at high risk for the development of another aortoenteric fistula. Serial screening by noninvasive imaging techniques, such as ultrasonography or computerized axial tomography, may be warranted in these patients.