Airway fire during awake tracheostomy using high-flow nasal oxygen.

High-flow nasal oxygen is increasingly used in complex head and neck surgical procedures and difficult airway management. We describe a case where an operating room fire occurred while using high-flow nasal oxygen during an awake tracheostomy for an obese patient in airway extremis due to supraglottitis. Shortly after the operation began, and before incision of the trachea, electrical diathermy applied to bleeding sub-cutaneous vessels ignited a small flame. This was extinguished without harm to the patient and the procedure was completed without further complication. Fire requires three components: fuel; heat; and an oxidiser. We speculate that high-flow oxygen channelled under the drapes and acted as the oxidiser; either tissue eschar or vapourised fat were the fuel; and the diathermy supplied a source of ignition to complete the fire triad. When using high flows of concentrated oxygen, practitioners should aim to minimise all of these factors and be alert for the risk of fire at every stage of the operation.

Segregation of transgenes in maize.

Progeny recovered from backcrossed transgenic maize tissue culture regenerants (R0) were analyzed to determine the segregation, expression, and stability of the introduced genes. Transgenic A188 x B73 R0 plants (regenerated from embryogenic suspension culture cells transformed by microprojectile bombardment; see [9]) were pollinated with nontransformed B73 pollen. Inheritance of a selectable marker gene, bar, and a nonselectable marker gene, uidA, was analyzed in progeny (R1) representing four independent transformation events. Activity of the bar gene product, phosphinothricin acetyltransferase (PAT), was assessed in plants comprising the four R1 populations. The number of R1 plants containing PAT activity per total number of R1 plants recovered for each population was 2/7, 19/34, 3/14 and 73/73. Molecular analysis confirmed the segregation of bar in three R1 populations and the lack of segregation in one R1 population. Cosegregation analysis indicated genetic linkage of bar and uidA in all four R1 populations. Analysis of numerous R2 plants derived from crossing transformed R1 plants with nontransformed inbreds revealed 1:1 segregation of PAT activity in three of four lines, including the line that failed to segregate in the R1 generation. Integrated copies of bar in one line appeared to be unstable or poorly transmitted.

Transformation of Maize Cells and Regeneration of Fertile Transgenic Plants.

A reproducible system for the generation of fertile, transgenic maize plants has been developed. Cells from embryogenic maize suspension cultures were transformed with the bacterial gene bar using microprojectile bombardment. Transformed calli were selected from the suspension cultures using the herbicide bialaphos. Integration of bar and activity of the enzyme phosphinothricin acetyltransferase (PAT) encoded by bar were confirmed in all bialaphos-resistant callus lines. Fertile transformed maize plants (R0) were regenerated, and of 53 progeny (R1) tested, 29 had PAT activity. All PAT-positive progeny analyzed contained bar. Localized application of herbicide to leaves of bar-transformed R0 and R1 plants resulted in no necrosis, confirming functional activity of PAT in the transgenic plants. Cotransformation experiments were performed using a mixture of two plasmids, one encoding PAT and one containing the nonselected gene encoding [beta]-glucuronidase. R0 plants regenerated from co-transformed callus expressed both genes. These results describe and confirm the development of a system for introduction of DNA into maize.

Analysis of lipid composition and morphological characteristics in soybean regenerants.

A study was conducted to examine the extent of somaclonal variation of soybean plants, Glycine max (L.) Merrill cv. 'McCall', regenerated via somatic embryogenesis from cultured immature cotyledons using two different protocols. The sexual progeny of regenerants were compared with normal, seed-derived populations for morphological characteristics and fatty acid composition of seeds. First generation progeny of regenerants showed greater phenotypic variation than the control population, but this variation was not observed in the second generation. No stable somaclonal variants for fatty acid composition of the seed oil or morphological characteristics were observed, indicating that this somatic embryogenesis system should be adaptable for transformation with minimal generation of unwanted variation.

Computer support for clinical and ancillary support areas.

Military medicine is aggressively meeting the need for enhanced information flow and improved efficiency in the delivery of health care by implementing automated systems. A Department of Defense (DOD) Agency, the Tri-Service Medical Information Systems (TRIMIS) Program office, is centrally procuring automated data processing to support clinical and patient appointment activities within the DOD health care system of 165 hospitals and 287 clinics. The procured systems are then implemented with the assistance of the military departments. Systems are now supporting cardiology, pharmacy, radiology, clinical laboratory, and patient appointment and scheduling. Capabilities of all these systems are detailed in the paper. To date, the TRIMIS efforts have contributed significantly to more efficient information processing, thus ensuring continued quality health care through the DOD.