Pulmonary vasodilatory effects of 12 and 60 parts per million inhaled nitric oxide in children with ventricular septal defect.
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Cardiac Catheterization↗
Biomedical subjects
J M Lynch
Publications and source records attributed to J M Lynch.
Laryngotracheal disruption from blunt pediatric neck injuries: impact of early recognition and intervention on outcome.
Blunt and penetrating neck injuries are an infrequent cause of morbidity and mortality in the pediatric population. Although less common than penetrating injuries, blunt pediatric neck injuries are more often life-threatening because of associated laryngotracheal disruption. The authors reviewed their experience with pediatric neck injuries over the past 5 years. There were nine blunt and 14 penetrating injuries, representing 0.5% of the trauma admissions. There was no significant difference in age or gender distribution between the two groups. Blunt pediatric neck injuries were more often associated with frank respiratory distress at the time of presentation. Massive subcutaneous emphysema and hoarseness were the most common symptoms encountered. All patients with blunt injury underwent direct laryngoscopy and bronchoscopy (DL & B) and esophagoscopy. DL & B results were positive for eight patients; seven patients underwent neck exploration and successful repair of the laryngotracheal injuries. There were two deaths; one of these patients had laryngeal transection, which was not recognized at the time of DL & B. The other death resulted from associated tracheobronchial disruption secondary to massive blunt chest trauma. The patients with penetrating neck injuries were more likely to be treated nonoperatively, to have a shorter stay in the hospital and intensive care unit, and to have a lower injury severity score. There were no deaths in this group. The authors conclude that all patients with blunt neck trauma should undergo emergent and meticulous DL & B. Visualization of laryngotracheal disruption mandates immediate neck exploration and primary repair.
Adolescent↗
Blunt urogenital trauma in prepubescent female patients: more than meets the eye!
Blunt traumatic injury to the urogenital region in the prepubescent girl is commonly evaluated in pediatric emergency departments (ED). The purpose of this study is: 1) to establish recommendations for an accurate, painless (both physically and psychologically), and timely diagnosis, and 2) to determine whether the ED examination can accurately determine the extent of the injury. Over a 24-month period (January 1991 through December 1992), 22 girls with blunt trauma to the urogenital region (mean age 5.7 years, range 2-9 years) were retrospectively evaluated. Initial ED evaluations were by both an emergency physician and a pediatric surgeon. All 22 patients underwent an examination under anesthesia (EUA) in the operating room to evaluate the extent of the injury and to repair the injury as needed. Follow-up was obtained in all patients and averaged 18 months. The findings at EUA demonstrated a significant disagreement with the preoperative ED evaluation. In only five patients was there agreement between the preoperative ED assessment and the findings during the EUA (24% concurrence). Thus, 16 patients (76%) had injuries of greater extent than was appreciated during the preoperative examination in the ED. Partial or complete disruption of the perianal sphincters occurred in six patients (27%) and was unrecognized preoperatively in each. Twenty-one of the 22 patients required suture repair of lacerations, the remaining patient did not require surgical therapy. Three patients had contusions or lacerations to the urethral area requiring repair and/or prolonged bladder catheter drainage for two to 14 days (average seven days). The average hospital stay was 19.3 hours. There were three minor wound complications following surgery: two required repeat EUA with suturing or cauterization, and one required no further therapy. This study clearly demonstrates that the ED examination, by both emergency physicians and pediatric surgeons, of young girls who have suffered blunt urogenital trauma grossly underestimates the severity of injuries when compared to the EUA in the operating room. EUA is safe and allows early discharge with minimal psychologic sequelae. Recommendations for mandatory EUA are made.
Accidents↗
Effects of multibuffer supplementation on acid-base balance and 2,3-diphosphoglycerate following repetitive anaerobic exercise.
The purpose of this investigation was to determine the effects of a 3.5-day dietary multibuffer supplement (containing predominantly inorganic phosphate, or Pi, along with bicarbonate and carnosine, i.e., PhosFuel) on repetitive (four trials separated by 2 min rest) Wingate test (WT) performances and whole blood 2,3-diphosphoglycerate (2,3-DPG) concentrations in 10 recreationally trained road cyclists (T) and 10 normally active but untrained (UT) men. A 2-week washout period was utilized between experimental sessions. Venous blood samples were obtained via cannula once before exercise (baseline), immediately post each WT, and 3 min after the final WT (recovery). The data indicate that this supplement does not affect acid-base status with following intense anaerobic exercise and does not improve repetitive WT performance. However, the supplement does enhance post-exercise levels of 2,3-DPG and the 2,3-DPG/Hb ratio in recreationally trained cyclists while improving acute recovery of peak power in these men.
2,3-Diphosphoglycerate↗
Impact of Field Release of Genetically Modified Pseudomonas fluorescens on Indigenous Microbial Populations of Wheat.
In a field release experiment, an isolate of Pseudomonas fluorescens, which was chromosomally modified with two reporter gene cassettes (lacZY and Kan(supr)-xylE), was applied to spring wheat as a seed coating and subsequently as a foliar spray. The wild-type strain was isolated from the phylloplane of sugar beet but was found to be a common colonizer of both the rizosphere and phylloplane of wheat as well. The impact on the indigenous microbial populations resulting from release of this genetically modified microorganism (GMM) was compared with the impact of the unmodified, wild-type strain and a nontreated control until 1 month after harvest of the crop. The release of the P. fluorescens GMM and the unmodified, wild-type strain resulted in significant but transient perturbations of some of the culturable components of the indigenous microbial communities that inhabited the rhizosphere and phylloplane of wheat, but no significant perturbations of the indigenous culturable microbial populations in nonrhizosphere soil were found. Fast-growing organisms that did not produce resting structures (for example, fluorescent pseudomonads and yeasts) seemed to be most sensitive to perturbation. In terms of hazard and risk to the environment, the observed microbial perturbations that resulted from this GMM release may be considered minor for several reasons. First, the recombinant P. fluorescens strain caused changes that were, in general, not significantly different from those caused by the unmodified wild-type strain; second, perturbations resulting from bacterial inoculations were mainly small; and third, the release of bacteria had no obvious effects on plant growth and plant health.
Journal Article↗
Responses of IGF-I to endogenous increases in growth hormone after heavy-resistance exercise.
The purpose of this study was to examine the effects of a heavy-resistance exercise protocol known to dramatically elevate immunoreactive growth hormone (GH) on circulating insulin-like growth factor I (IGF-I) after the exercise stimulus. Seven men (23.1 +/- 2.4 yr) volunteered to participate in this study. Each subject was asked to perform an eight-station heavy-resistance exercise protocol consisting of 3 sets of 10 repetition maximum resistances with 1-min rest between sets and exercises followed by a recovery day. In addition, a control day followed a nonexercise day to provide baseline data. Pre- and postexercise (0, 15, and 30 min) blood samples were obtained and analyzed for lactate, creatinine kinase, GH, and IGF-I. Postexercise values for lactate and GH were significantly (P < 0.05) elevated above preexercise and resting baseline values. The highest mean GH concentration after the heavy-resistance exercise protocol was 23.8 +/- 11.8 micrograms/l, observed at the immediate postexercise time point. Significant increases in creatine kinase were observed after the exercise protocol and during the recovery day. No significant relationships were observed between creatine kinase and IGF-I concentrations. No significant changes in serum IGF-I concentrations were observed with acute exercise or between the recovery and control days. Thus, these data demonstrate that a high-intensity bout of heavy-resistance exercise that increases circulating GH did not appear to affect IGF-I concentrations over a 24-h recovery period in recreationally strength-trained and healthy young men.
Adult↗
Is it quality assurance or quality improvement; and what is it?
The term quality has a different meaning for everyone. Persons seeking health care have predetermined expectations that the care they receive is efficient, effective, and meets their needs. Through nursing quality improvement programs, nurses themselves can evaluate the efficiency of the care they provide. Through the use of patient surveys, nurses become aware of the patient's needs and degree of satisfaction. Monitor tools based on nursing standards and policies are used to assess the components of care. A successful nursing quality improvement program requires a climate that educates, supports, and encourages staff involvement.
Humans↗
Exercise induced asthma: a clinical perspective.
Exercise is a very common precipitant of asthma. Inflammation and edema are felt to be important components of the asthmatic response. Heat and water loss from the airway mucosa are most likely important in its pathogenesis, although the exact etiology remains unknown. A good history combined with proper diagnostic testing can usually determine the diagnosis, and prevention is the key to effective management. Although modified training techniques are often helpful, medications are usually needed for both prevention and treatment. While antiinflammatory agents are gaining therapeutic importance, inhaled beta-agonists remain the treatment of choice. With appropriate diagnosis and management, exercise-induced asthma should not limit participation nor performance in athletics for the great majority of the population.
Administration, Inhalation↗
Effect of acid-base balance on the growth hormone response to acute high-intensity cycle exercise.
To investigate the effect of acid-base balance on serum human growth hormone (hGH) concentration after an acute high-intensity anaerobic exercise bout, 10 untrained but normally active men [age, 24.6 +/- 1.5 (SE) yr] participated in a randomized double-blind counterbalanced experiment. Each subject reported in a fasted state at the same time of day for two experimental sessions separated by 1 wk. For each session, subjects were administered a decaffeinated tea solution containing either 0.3 g NaHCO3/kg body wt [alkalosis (ALK)] or 0.04 g NaCl/kg body wt [control (CTRL)] over a 45-min ingestion period. Venous blood samples were obtained before [baseline (BL)] and 75 min after the ingestion period, as well as postexercise at 0, 5, 10, 15, 20, and 30 min. The exercise task immediately followed the preexercise blood draw and consisted of 90 s of maximal-effort cycle ergometry against an opposing force of 0.49 N (0.05 kg)/kg body wt. There were no differences between the ALK and CTRL conditions in mean or peak power output or total work during the exercise task. Whole blood pH was significantly (P < or = 0.05) elevated in ALK above CTRL at all time points except BL. Postexercise serum hGH concentration significantly increased above BL at 10, 15, 20, and 30 min in CTRL and at 20 and 30 min in ALK. The hGH concentration was significantly lower in ALK than in CTRL at 15, 20, and 30 min postexercise. These data indicate that an increase in blood hydrogen ion concentration may be partly responsible for the hGH response to acute high-intensity anaerobic exercise.
Acid-Base Equilibrium↗
Catecholamine responses to short-term high-intensity resistance exercise overtraining.
Seventeen weight-trained males were divided into an overtraining group [OT; n = 11; age = 22.0 +/- 0.9 (SE) yr] that weight trained their legs daily for 2 wk with 100% 1 repetition maximum relative intensity on a squat machine and a control group (n = 6; age = 23.7 +/- 2.4 yr) that exercised 1 day/wk with low relative intensity (50% 1 repetition maximum). Test batteries including strength assessments and resting and exercise-induced concentrations of epinephrine and norepinephrine were conducted at the beginning, middle, and end (tests 1-3, respectively) of the study. Strength capabilities decreased by test 3 for the OT group (P < 0.05). Resting catecholamine concentrations did not change for either group during the study, whereas exercise-induced concentrations of both epinephrine (test 1 = 3,407.9 +/- 666.6 pmol/l, test 2 = 7,563.7 +/- 1,210.6 pmol/l, test 3 = 6,931.6 +/- 919.3 pmol/l) and norepinephrine (test 1 = 42.9 +/- 7.4 nmol/l, test 2 = 70.0 +/- 8.8 nmol/l, test 3 = 85.2 +/- 14.5 nmol/l) significantly increased by tests 2 and 3 for only the OT group. Correlation coefficients suggested decreased responsitivity of skeletal muscle to sympathetic nervous system activity. It appears that altered exercise-induced sympathetic nervous system activity accompanies high relative intensity resistance exercise overtraining and may be among the initial responses to the onset of the previously theoretical sympathetic overtraining syndrome.
Adult↗
Effects of amount of protein and ruminally protected amino acids in the diet of dairy cows fed supplemental fat.
The objectives of this experiment were to investigate the effects of amount of dietary CP and ruminally protected AA supplementation on production of milk and milk components, ruminal fermentation, and nutrient digestibilities by cows fed diets containing high oil corn and tallow. Holstein cows in midlactation producing 22 to 25 kg/d of milk were used in a 5 x 5 Latin square design. Treatments were 1) control (16.8% CP, no added fat); 2) 14.2% CP, no AA; 3) 14.2% CP, with AA; 4) 17.5% CP, no AA; and 5) 17.5% CP, with AA. Diets 2 to 5 contained supplemental fat from high oil corn and tallow. Diets consisted of 33% alfalfa haylage, 17% corn silage, and 50% concentrate DM. Intake of DM was not different among treatments. Dietary fat increased yields of milk, fat, SNF, and total solids and percentages of fat and total solids. Increasing CP from 14.2 to 17.5% did not alter production or composition of milk. Supplemental AA increased yields of 4% FCM, milk fat, milk CP, true protein, and casein protein and percentages of CP, true protein, and casein protein in milk when either 14.2 or 17.5% CP was in the diet. Supplemental fat did not alter ruminal fermentation, but increases in dietary CP increased total VFA concentration in the rumen without affecting proportions of individual VFA. Apparent digestibilities of DM, OM, CP, starch, and energy in the total tract were greater for cows fed the 17.5% CP diets. Addition of AA to the 14.2% CP diet increased apparent digestibilities of DM, OM, ADF, NDF, and energy in the total tract but decreased digestibilities for cows fed the 17.5% CP diets. Feeding AA to midlactation cows in diets containing supplemental fat may alleviate the decrease in milk protein percentage associated with fat supplementation; this response was similar for cows fed diets that contained either 14.2 or 17.5% CP.
Amino Acids↗
Performance decrements with high-intensity resistance exercise overtraining.
The purpose of this investigation was to study a high-intensity resistance exercise overtraining protocol resulting in muscular strength decrements. Seventeen weight-trained males were divided into an overtraining group (OT; N = 11; mean +/- SE, age = 22.0 +/- 0.9 yr,) that exercised on a squat machine daily for 2 wk with 100% of 1 repetition maximum (RM) relative intensity, and a control group (CON; N = 6; age = 23.7 +/- 2.4 yr) that exercised 1 d.wk-1 with low intensity (50% 1 RM). Test batteries were conducted at the beginning (test 1), after 1 wk (test 2), and after 2 wk (test 3) of the study. One RM performance significantly decreased from test 1 to test 3 (P < 0.05) for the OT group (mean = -12.2 +/- 3.8 kg), but not the CON group (mean = -1.1 +/- 0.8 kg). Isokinetic and stimulated isometric muscle force significantly decreased for the OT group compared with the CON group by test 3. The primary site of maladaptation appeared to be in the periphery as indicated by changes in stimulated force, circulating CK activity, and exercise-induced lactate responses. This protocol produced a significant decrease in 1 RM performance, thus providing a model for the study of short-term, high-intensity resistance exercise overtraining.
Adaptation, Physiological↗
Is early discharge following isolated splenic injury in the hemodynamically stable child possible?
Nonoperative treatment of splenic injury is well accepted. Two questions have not been answered. (1) What is the intensity of monitoring required in the hemodynamically stable patient? (2) How long do patients need to be hospitalized? Ninety-one patients having computed tomography (CT) or surgically proven splenic injury were treated between September 1986 and September 1991. Excluded from the study were 16 patients requiring operation and 22 patients having multiple system injuries. All operations occurred within 24 hours of admission. No transfusions were required later than 48 hours following admission. The remaining 53 patients (58%) constitute the study group. CT classification of Buntain indicated 6 class I, 21 class II, 24 class III, and 2 class IV injuries. The mean Injury Severity Score (ISS) for the group was 6.98 +/- 3.43. Serial hematocrits for the patients treated without transfusions were followed until three consecutive determinations showed no change. The lowest average hematocrit for the nontransfused group was 30.96% +/- 4.47% and occurred on day 2.06 +/- 0.76. Eleven patients (23%) had left-sided pleural effusions that resolved without intervention. One patient had an ileus for 3 days. CT or ultrasound examination was obtained on day 5 to 7 to document healing before the patient was allowed out of bed and discharged. The average hospital stay was 7.06 +/- 2.24 days. Twenty-two patients were initially observed in the intensive care unit (ICU). Clearly the interval between hematocrit stability (average, 2.06 days) and discharge (average, 7.06 days) constitutes a time of minimal nursing care while utilizing bed space and health care dollars.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Isolation and characterization of actinomycete antagonists of a fungal root pathogen.
By use of selective media, 267 actinomycete strains were isolated from four rhizosphere-associated and four non-rhizosphere-associated British soils. Organic media with low nutrient concentrations were found to be best for isolating diverse actinomycetes while avoiding contamination and overgrowth of isolation media by eubacteria and fungi. While all isolates grew well at pHs 6.5 to 8.0, a few were unable to grow at pH 6.0 and a significant number failed to grow at pH 5.5. Eighty-two selected isolates were screened for in vitro antagonism towards Pythium ultimum by use of a Difco cornmeal agar assay procedure. Five isolates were very strong antagonists of the fungus, four were strong antagonists, and ten others were weakly antagonistic. The remaining isolates showed no antagonism by this assay. Additional studies showed that several of the P. ultimum antagonists also strongly inhibited growth of other root-pathogenic fungi. Twelve isolates showing antifungal activity in the in vitro assay were also tested for their effects on the germination and short-term growth of lettuce plants in glasshouse pot studies in the absence of pathogens. None of the actinomycetes prevented seed germination, although half of the isolates retarded seed germination and outgrowth of the plants by 1 to 3 days. During 18-day growth experiments, biomass yields of some actinomycete-inoculated plants were reduced in comparison with untreated control plants, although all plants appeared healthy and well rooted. None of the actinomycetes significantly enhanced plant growth over these short-term experiments. For some, but not all, actinomycetes, some correlations between delayed seed germination and reduced 18-day plant biomass yields were seen. For others, plant biomass yields were not reduced despite an actinomycete-associated delay in seed germination and plant outgrowth. Preliminary glasshouse experiments indicated that some of the actinomycetes protect germinating lettuce seeds against damping-off caused by P. ultimum.
Journal Article↗
The use of drugs in emergency airway management in pediatric trauma.
Most patients who require emergency airway control receive drugs to induce rapidly sufficient anesthesia for direct laryngoscopy and endotracheal intubation, but there are no protocols that outline the use of specific drugs in general use. Drugs should safely and rapidly produce (1) unconsciousness; (2) paralysis; and (3) blunt intracranial pressure (ICP) responses to airway procedures. Consequences to be considered include increased ICP, hemorrhagic shock, and a full stomach. To refine the use of drugs used for airway procedures in pediatric trauma patients, the authors reviewed all cases of emergency endotracheal intubation over a recent 12-month period (1) to see whether medications used met the goals of producing unconsciousness and paralysis and blunting ICP responses were met safely; and (2) to identify potential drug-related complications. From July 1, 1990, to June 30, 1991, 60 of 791 children (7.6%) required endotracheal intubation at the scene of injury, at the referring hospital, or in our emergency department (15; 25%). Ten patients died (16.7%). Three fourths were younger than 9 years of age. All except one suffered blunt injuries. Nearly all (95%) suffered head injuries, isolated in 39 of 57 (68.4%) and combined with injuries in other regions in 18 (31.6%). Fifteen patients were in apnea (25%); seven were both apneic and pulseless. Three fourths (45 of 60) had diminished levels of consciousness; one fourth (15 of 60) were awake. Immediate endotracheal intubation proceeded appropriately without drugs in all seven patients in cardiopulmonary arrest. Only eight of the remaining 53 patients (15.1%) received an optimal medication regimen. Many patients with head injury were inadequately protected against increases in ICP. Thiopental, an effective anesthetic agent that effectively lowers intracranial pressure, was not used in 25 of 35 stable patients with isolated head injury (71.4%). Intravenous lidocaine was not used in 38 of 50 head-injured patients in whom it would have been an appropriate adjunct to control increases in ICP (76%). Eight patients received paralyzing agents alone, without sedatives or narcotics. Medications were thought inadequate to relieve the pain and discomfort of laryngoscopy and endotracheal intubation in 32 of the 53 patients who should have received them (60.4%). No paralyzing agents were used in 36 of the 53 instances where it would have been appropriate (67.9%). In two of 11 instances (18.3%) where succinylcholine was administered, no prior nondepolarizing agent was used. Complications of a full stomach at the time of emergency endotracheal intubation became evident in 10 patients (16.7%) who vomited during procedures to control the airway. Two patients (3.3%) aspirated.(ABSTRACT TRUNCATED AT 400 WORDS)
Adjuvants, Anesthesia↗
Effect of a prolonged-release formation of N-methionyl bovine somatotropin (sometribove) on milk composition.
Forty Holstein cows received bi-weekly injections of prolonged-release formulation of bST, and 39 received bi-weekly injections of excipient, in a study to evaluate the effects of long-term bST administration on milk composition and component production. Injections began at 60 +/- 3 d postpartum. Administration of bST increased production of milk and of all measured components. Concentrations of lactose (4.85 and 4.81%), fat (3.76 and 3.67%), total solids (12.57 and 12.44%), SNF (8.83 and 8.75%), casein (2.56 and 2.53%), and true protein (3.13 and 3.08%) were similar in milks from cows receiving bST and excipient, respectively. Percentages of NPN (times 6.38) and total protein were greater in milk from bST-treated cows (.179% NPN and 3.32% total protein) compared with milk from cows injected with excipient (.172% NPN and 3.24% total protein). Use of bST did not change the relative percentages of alpha s-casein, beta-casein, kappa-casein, beta-lactoglobulin, alpha-lactalbumin, or casein proteolysis products. A cyclical pattern of milk production, component production, and composition within each 14-d injection interval was observed. This suggests that a diminishing amount of bST was delivered during the latter third of each injection interval. There were no effects of bST on milk composition that would be of any practical significance to dairy product manufacturers or consumers.
Animals↗
Effect of a prolonged-release formulation of N-methionyl bovine somatotropin (sometribove) on milk fat.
Nine Holstein cows were injected bi-weekly with a prolonged-release formulation of N-methionyl bST, and 9 cows were injected with excipient. Intramuscular injections began at 60 +/- 3 d postpartum and continued at 14-d intervals for the full lactation. Administration of bST increased production of milk, total fat, and all milk fat components measured. Average fatty acid composition of milk fat was not influenced by bST treatment. Stage of lactation had a large influence on production and percentage of individual fatty acids in milk fat from both bST-treated and control cows. The stage of lactation impact on the fatty acid composition of milk fat reflected changes in the relative contributions of body fat mobilization and de novo synthesis of milk fat components in response to changes in energy balance. Initiation of bST treatment caused some transient changes in milk fatty acid composition that were related to energy balance. These changes were small compared with the normal changes because of stage of lactation in all cows. Phospholipid and cholesterol content of milk also changed with stage of lactation but were not influenced by bST treatment. Melting properties of milk fat were influenced greatly by stage of lactation. Bovine somatotropin did not cause any changes in composition or physical properties of milk fat that were outside the range of normal variation.
Animals↗
Beneficial interactions between micro-organisms and roots.
Microbial activity in the rhizosphere can have positive and negative effects on plants. Some of the beneficial processes act by minimizing the negative effects or by modifying the cropping environment to enhance productivity. Processes that are considered here include the provision of nitrogen, phosphorus and iron to the plant, the biocontrol of diseases and deleterious organisms and the stabilization of soil structures. The use of genetic engineering techniques in studying these processes and generating novel strains which may enhance them is discussed, along with the possible consequences of the release of organisms into the environment.
Journal Article↗