Abbreviations & Acronyms BICU = burn intensive care unit LOS = length of stay STSG = split thickness skin graft/debridement TBSA = total body surface area UTI = urinary tract infection Correspondence: Ronald S

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For the first time in modern history burn centers must face the reality of having to potentially care for a staggering number of injured patients. Factors such as staffing, patient acuity and bed availability compel medical professionals to regularly examine various aspects of their respective healthcare delivery systems, especially with regards to how these systems should function for mass casualty response. The majority of burn care in New Jersey is provided by one designated burn treatment facility. A planning group was formed to identify additional hospital support systems capable of providing short-term patient care during a disaster. Focus was on three key areas: identifying actual versus potential nonburn center resources, ascertaining the number and level of burn expertise at these facilities, and assessing the capacities of any available resources and personnel. Retrospective review of discharge data highlighted which of the more than seventy New Jersey hospitals besides The Burn Center were treating and releasing burn injures. In a disaster The Burn Center designates these hospitals as Tier Facilities to serve as additional resources until patients may be transferred to other recognized regional and national burn centers. Triage is conducted in accordance with the American Burn Association Benefit-to-Ratio Triage grid, matching patient acuity with each hospital's tier designation. A secondary triage, conducted 24 hours after the initial incident, identifies which patients require transport for more specialized burn care. Twenty-seven burn centers from Maine through Maryland and the District of Columbia, who have joined together as a Consortium, agree to support one another for optimal patient distribution and management in accordance with accepted national standards of care. State Medical Coordination Centers equipped to coordinate and track transport of large numbers of injured personnel are able to facilitate this collaborative, multiagency response throughout the northeast region. Burn centers share many issues common to emergency preparedness. Paramount among them is an ability to provide quality burn care for the greatest number of patients at a time when staff and resources will be severely limited. It is incumbent upon burn centers to explore opportunities extending beyond individual state and regional resources in order for centers to continually maintain this standard of care, particularly in a disaster.

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Purpose: To evaluate the role of autophagy related gene 7 (ATG7) in non-melanoma skin cancer. Subjects and Methods: This retrospective and prospective case-control study was performed on 104 patients with non-melanoma skin cancer (NMSC) in addition to 20 apparently healthy subjects matched for age and sex as a control group. Multiple skin biopsies were taken for immunohistochemical evaluation of ATG7 expression. Results: Both epithelial and stromal ATG7 were expressed in all participants while all patients showed nucleocytoplasmic localization and controls showed both cytoplasmic and nucleocytoplasmic expression. In addition, significantly higher H-scores of ATG7 in both epithelium and stroma were detected in patients compared to controls (P<0.001). Conclusion: ATG7 nucleocytoplasmic topographic localization might be involved in the pathogenesis of NMSC, which can open the gate for new target therapy for this skin cancer.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon neoplasm of the skin and soft tissue, commonly appearing on the trunk and extremities. The occurrence of DFSP in the breast is extremely rare. It has low to intermediate malignant potential with a high rate of local recurrence and invasion. We present a case of a 28-year- old female with a skin lesion on the breast associated with an underlying breast lump. We aim to discuss the sonographic and magnetic resonance findings of breast dermatofibrosarcoma.

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The study assesses the global annual cost of people living with HIV (PLWHIV) in France in 2013 and affiliated to the general insurance scheme during 2008-2015. Methods: We performed a retrospective cohort study in the SNIIRAM database containing individualized data on all reimbursed health expenses for the French population. PLWHIV were identified by specific chronic diseases status and/or reimbursement of HIV laboratory tests and/or HIV-related hospitalizations and/or reimbursements of antiretroviral drugs in 2013. Each patient was followed two years after his inclusion. Hospital and outpatient costs were estimated and categorized in 13 subgroups: antiretroviral drugs, daily sick leave benefits, other drugs, paramedical visits, general practitioner visits, specialist visits, medical devices, transports, laboratory tests, other outpatient costs, hospital stays, hospital outpatient consultations and hospital at home. Costing was performed considering French official tariffs for 2013 and 2014 and expressed in 2019 euros. Results: A cohort of 96,423 PLWHIV was identified. Mean age was 47.5 years old (612), 65% were men, and most frequent treatments outside HIV drugs were treatments for cardiovascular disease (20%), psychotropic treatments (16%) and liver disease (15%). The total annual cost of PLWHIV was calculated to V1.4 billion, split into antiretroviral drugs for 63% (870MV), hospital stays for 11% (154MV), daily sick leave benefits for 8% (116MV), other drugs for 5% (73MV). The median annual cost per patient was estimated to be V12,094 [610,801, Q1: 9,001, Q3: 16,795], varying from V618 for 0-10 years old PLWHIV to V13,725 for 51-60 years old PLWHIV, V11,969 for incident patients (N=3,373), and V13,560 for patients with at least one comorbidity. Conclusions: This study shows that the global annual cost of PLWHIV is mainly charged to antiretroviral drugs cost. Only thin disparities in total cost were observed in each group (age, incident, comorbidity), advanced analyses such as Machine Learning could identify significantly overexpressing cost profiles.