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PubMed2002

The relationship between hand-arm vibration and lower extremity clinical manifestations: a review of the literature.

OBJECTIVE: To assess the current literature supporting a relationship between hand-arm vibration (HAV) and lower extremity clinical effects. METHODS: An initial review of the literature identified lower extremity vascular and neurological effects reported in association with HAV. A second literature review was performed with explicit search and evaluation strategies. It focused on analytical studies and looked for epidemiological evidence supporting the relationship between HAV and lower extremity effects. RESULTS: Eight analytical studies which met all of the initial inclusion/exclusion criteria were identified. All of these had serious validity deficiencies with respect to selection bias, response rates and lack of examination of confounders. CONCLUSIONS: There was consistency with respect to an association between those exposed who were diagnosed with hand-arm vibration syndrome (HAVS) and vascular symptoms in the lower extremities. There was no evidence that hand-held vibration exposure independent of the diagnosis of HAVS was associated with lower extremity vascular symptoms. There was no evidence to suggest that HAV was associated with clinically significant lower extremity neurological symptoms.

Arm↗
PubMed2001

Acute ischemia of the upper extremity: long-term results following thrombembolectomy with the Fogarty catheter.

OBJECTIVE: In 1962, the procedure of arterial thrombembolectomy with the Fogarty catheter was established. Numerous studies have been published studying thrombembolectomies of the lower extremities. Limited information, however, is available following thrombembolectomy of the upper extremity after arterial occlusion. The aim of the present study, therefore, was to determine long-term results (3-5 years after thrombembolectomy) following thrombembolectomy of the upper extremity with the Fogarty catheter in a large retrospective clinical study. DESIGN: In the present study, 251 patients were encountered. Over a period of 20 years, 283 thrombembolectomies with the Fogarty catheter were performed on the upper extremity at the surgical department of the University of Munich. MAIN OUTCOME MEASUREMENTS: The appearance of local and general complications in the postoperative phase, as well as long-term results, were evaluated. RESULTS: The results indicate that general complications - i.e., cardiac insufficiency, cerebral ischemia, etc. - occurred in 18 patients (7.2%). Local complications - i.e., wound infection, persistence of ischemia, or hematoma - were evident in 51 patients (20.3%). Re-occlusion following thrombembolectomy was found in 21 patients (8.8%). The affected extremity had to be amputated in five cases (2.0%), and 14 patients (5.6%) died during the postoperative phase. As a result of multimorbidity of the patients and average age at the time of surgery (73 years), 40% of the patients had died before the date of examination. Nonetheless, 111 patients of the 117 living patients showed no complaints or minor coldness and pain following heavy exercise. CONCLUSIONS: The results of the present study indicate that, in most cases, thrombembolectomy with the Fogarty catheter represents a successful surgical method for the acute treatment of arterial occlusion of the upper extremity.

Adult↗
PubMed1996

Aortic regurgitation complicated by extreme left ventricular dilation: long-term outcome after surgical correction.

OBJECTIVES: This study sought to determine the outcome of aortic valve replacement for aortic regurgitation complicated by extreme left ventricular dilation. BACKGROUND: Aortic valve replacement has been recommended in aortic regurgitation with extreme left ventricular dilation (diastolic dimension >/= 80 mm), but extreme left ventricular dilation raises concern about irreversible left ventricular dysfunction. METHODS: Thirty-one patients with a preoperative echocardiographic diastolic dimension >/= 80 mm (group 1) undergoing operation for severe isolated aortic regurgitation between 1980 and 1989 were compared with 188 patients with a diastolic dimension <80 mm operated on during the same period (group 2). RESULTS: Preoperatively, extreme left ventricular dilation was seen only in male patients and was associated with a reduced ejection fraction (43 +/- 12% vs. 53 +/- 11% [mean +/- SD], p < 0.0001). The postoperative outcome of group 1 was compared with that of male patients in group 2 (group 2M, n = 144). The operative mortality rates for groups 1 and 2M were 0% and 5.6%, respectively (p = 0.35). Late survival in operative survivors was similar in groups 1 and 2M, but compared with expected survival, an excess mortality was observed for group 1 (p = 0.024). Preoperative ejection fraction, but not diastolic dimension, independently predicted late survival and postoperative ejection fraction. Postoperatively, groups 1 and 2M showed a similar improvement in ejection fraction, but persistent left ventricular enlargement was more frequent in group 1. CONCLUSIONS: Extreme left ventricular dilation due to aortic regurgitation is observed in male patients and is frequently associated preoperatively with a reduced ejection fraction but is not a marker of irreversible left ventricular dysfunction. Operative risk and late postoperative survival are acceptable in these patients, although a late excess mortality, predicted best by preoperative ejection fraction, is observed. Therefore, extreme left ventricular dilation is not a contraindication to operation, which should be performed before left ventricular dysfunction occurs.

Aged↗
PubMedDate not supplied

The impact of diabetes-related lower-extremity amputations in The Netherlands.

The purpose of this study is to identify the incidence of diabetes-related lower-extremity amputations in the Netherlands. We used discharge records from SIG Health Care Information for every hospitalization for a lower-extremity amputation in all hospitals in the Netherlands in 1992. Age- and gender-specific population figures and diagnosed cases of diabetes were obtained from the Central Bureau of Statistics. Age- and gender-adjusted amputation incidences were identified at four different levels (toe, foot, leg, and thigh). Multiple amputations were analyzed by the highest level. Of all lower-extremity amputations, 1,575 (47%) were in persons with diabetes mellitus. Age- and gender-adjusted lower-extremity amputation rates per 10,000 persons with diabetes by level were the following: toe 12.39, foot 2.42, leg 7.82, thigh 2.54, and total 25.17. People with diabetes were 20.3 times more likely to experience a lower-extremity amputation than people without diabetes. Males were at a significantly higher risk of experiencing an amputation than females. There was a significant increase in the age-specific incidence of amputations as age increased. The most common amputation procedure performed was the toe amputation. There was a significant increase in thigh amputations as age increased, indicating that as people get older they suffer higher levels of amputations. Although the incidence of lower-extremity amputations was lower than previous reports, they still have a serious impact on the health-care system in the Netherlands.

Adult↗
PubMed2005

Effects of vehicle bumper height and impact velocity on type of lower extremity injury in vehicle-pedestrian accidents.

In nonfatal passenger vehicle-pedestrian accidents, the lower extremities are the most commonly injured body parts. The European Enhanced Vehicle-safety Committee Working Group 17 (EEVC/WG17) pedestrian subsystem test method using a legform impactor has been developed mainly for evaluation of aggressiveness of the front bumper of passenger vehicles. However, in recent years the number of sports utility vehicles (SUV) with a high bumper has been rapidly increasing. Since the bumper height is different between a passenger vehicle and an SUV, the type of lower extremity injury may be different. The type of lower extremity injury caused by this different bumper height should be clarified, because the test method and vehicle safety countermeasure must take into account a certain type of injury. Furthermore, the effect of vehicle impact velocity on the type of lower extremity injury in vehicle-pedestrian accidents has not been investigated so far. Therefore, the objective of this study is to clarify the effect of vehicle bumper height and vehicle impact velocity on the type of lower extremity injury in vehicle-pedestrian accidents. The Pedestrian Crash Data Study (PCDS), an in-depth accident database in the USA, was used for the current analyses. The results indicate that the type of injury, i.e., to the tibia and knee ligament, could become an injury to the femur with an increase in bumper height. Furthermore, the main injury at an impact velocity of around 20-30km/h is to the knee ligament. On the other hand, the main injury at an impact velocity of around 40km/h is a fracture of the lower extremities.

Accidents, Traffic↗
PubMed2004

Long-term follow-up of patients with suspected deep vein thrombosis of the upper extremity: survival, risk factors and post-thrombotic syndrome.

BACKGROUND: The outcome of upper extremity thrombosis in terms of morbidity, mortality and arm functionality is virtually unknown. We investigated mortality, risk factors, recurrent thrombosis and post-thrombotic syndrome (PTS) in patients with suspected upper extremity thrombosis. METHODS: Consecutive patients suspected of having deep vein thrombosis (DVT) of the upper extremity were followed for up to 53 months (mean 21 months). Venography and/or ultrasonography was used for diagnosis. Risk factors were identified from history and thrombophilia laboratory screening. PTS was assessed using a scoring system. Death, recurrent thrombosis and PTS were primary outcome measures. RESULTS: DVT of the upper extremity was diagnosed in 50 of 116 consecutive patients (43%). Malignancy and/or central venous lines were present in 37 of 50 (74%) patients with thrombosis. Inherited thrombophilia was diagnosed in 6 of 30 (20%) and 4 of 33 (12%) of the investigated patients with and without thrombosis, respectively (not significant). Twenty-five patients (50%) with thrombosis died during the follow-up period; this was associated with cancer in 84% of the deaths. Recurrent thrombosis was observed in four patients (8%) during follow-up. Symptoms of PTS were present in 4 of 22 patients (18%) with thrombosis and in 14 of 36 patients (39%) in whom thrombosis was excluded. CONCLUSIONS: Malignancy and central venous lines are major risk factors of upper extremity thrombosis. Thrombophilia seems to be unrelated to the presence or absence of upper extremity thrombosis. Thrombosis in combination with malignancy predicts poor survival. A scoring system can be used to assess the severity of PTS, but it does not discriminate PTS from other causes of arm complaints.

Journal Article↗
PubMed2006

Extreme between-study homogeneity in meta-analyses could offer useful insights.

OBJECTIVES: Meta-analyses are routinely evaluated for the presence of large between-study heterogeneity. We examined whether it is also important to probe whether there is extreme between-study homogeneity. STUDY DESIGN: We used heterogeneity tests with left-sided statistical significance for inference and developed a Monte Carlo simulation test for testing extreme homogeneity in risk ratios across studies, using the empiric distribution of the summary risk ratio and heterogeneity statistic. A left-sided P=0.01 threshold was set for claiming extreme homogeneity to minimize type I error. RESULTS: Among 11,803 meta-analyses with binary contrasts from the Cochrane Library, 143 (1.21%) had left-sided P-value <0.01 for the asymptotic Q statistic and 1,004 (8.50%) had left-sided P-value <0.10. The frequency of extreme between-study homogeneity did not depend on the number of studies in the meta-analyses. We identified examples where extreme between-study homogeneity (left-sided P-value <0.01) could result from various possibilities beyond chance. These included inappropriate statistical inference (asymptotic vs. Monte Carlo), use of a specific effect metric, correlated data or stratification using strong predictors of outcome, and biases and potential fraud. CONCLUSION: Extreme between-study homogeneity may provide useful insights about a meta-analysis and its constituent studies.

Databases, Bibliographic↗
PubMed2002

Extreme pathway analysis of human red blood cell metabolism.

The development of high-throughput technologies and the resulting large-scale data sets have necessitated a systems approach to the analysis of metabolic networks. One way to approach the issue of complex metabolic function is through the calculation and interpretation of extreme pathways. Extreme pathways are a mathematically defined set of generating vectors that describe the conical steady-state solution space for flux distributions through an entire metabolic network. Herein, the extreme pathways of the well-characterized human red blood cell metabolic network were calculated and interpreted in a biochemical and physiological context. These extreme pathways were divided into groups based on such criteria as their cofactor and by-product production, and carbon inputs including those that 1) convert glucose to pyruvate; 2) interchange pyruvate and lactate; 3) produce 2,3-diphosphoglycerate that binds to hemoglobin; 4) convert inosine to pyruvate; 5) induce a change in the total adenosine pool; and 6) dissipate ATP. Additionally, results from a full kinetic model of red blood cell metabolism were predicted based solely on an interpretation of the extreme pathway structure. The extreme pathways for the red blood cell thus give a concise representation of red blood cell metabolism and a way to interpret its metabolic physiology.

2,3-Diphosphoglycerate↗
PubMed2003

Analysis of metabolic capabilities using singular value decomposition of extreme pathway matrices.

It is now possible to construct genome-scale metabolic networks for particular microorganisms. Extreme pathway analysis is a useful method for analyzing the phenotypic capabilities of these networks. Many extreme pathways are needed to fully describe the functional capabilities of genome-scale metabolic networks, and therefore, a need exists to develop methods to study these large sets of extreme pathways. Singular value decomposition (SVD) of matrices of extreme pathways was used to develop a conceptual framework for the interpretation of large sets of extreme pathways and the steady-state flux solution space they define. The key results of this study were: 1), convex steady-state solution cones describing the potential functions of biochemical networks can be studied using the modes generated by SVD; 2), Helicobacter pylori has a more rigid metabolic network (i.e., a lower dimensional solution space and a more dominant first singular value) than Haemophilus influenzae for the production of amino acids; and 3), SVD allows for direct comparison of different solution cones resulting from the production of different amino acids. SVD was used to identify key network branch points that may identify key control points for regulation. Therefore, SVD of matrices of extreme pathways has proved to be a useful method for analyzing the steady-state solution space of genome-scale metabolic networks.

Algorithms↗
PubMed1998

Infection in the ischemic lower extremity.

Infections in the lower extremity of the patient with ischemia can cover a broad spectrum of different diseases. An understanding of the particular pathophysiologic circumstances in the ischemic extremity can be of great value in understanding the natural history of the disease and the potential complications that may occur. Optimizing blood flow to the extremity by using revascularization techniques is important for any patient with an ischemic lower extremity complicated by infection or ulceration. Infections in the ischemic lower extremity require local débridement and systemic antibiotics. For severe infections, such as necrotizing fasciitis or the fetid foot, more extensive local débridement and even amputation may be required. Fundamentals of managing prosthetic graft infection require removing the infected prosthesis, local wound débridement, and systemic antibiotics while attempting to preserve viability of the lower extremity using autogenous graft reconstruction.

Amputation, Surgical↗
PubMed2002

Adolescent exposure to extremely violent movies.

PURPOSE: To determine exposure of young adolescents to extremely violent movies. DESIGN: Cross-sectional school-based survey of middle school students at 15 randomly selected New Hampshire and Vermont middle schools. Each survey contained a unique list of 50 movies, randomly selected from 603 top box office hits from 1988 to 1999, 51 of which were determined by content analysis to contain extremely violent material. Movie titles only were listed, and adolescents were asked to indicate which ones they had seen. Each movie appeared on approximately 470 surveys. We calculated the percentage of students who had seen each movie for a representative subsample of the student population. We also examined characteristics associated with seeing at least one extremely violent movie. Complete survey information was obtained from 5,456 students. The sample was primarily white and equally distributed by gender. RESULTS: On average, extremely violent movies were seen by 28% of the students in the sample (range 4% to 66%). The most popular movie, Scream, was seen by two-thirds of students overall and over 40% of fifth-graders. Other movies with sexualized violent content were seen by many of these adolescents. Examples include The General's Daughter (rated R for "graphic images related to sexual violence including a rape scene and perverse sexuality") and Natural Born Killers (rated R for "extreme violence and graphic carnage, shocking images, language, and sexuality"), seen by 27% and 20%, respectively. Older students, males, those of lower socioeconomic status, and those with poorer school performance were all significantly more likely to have seen at least one extremely violent movie. CONCLUSION: This study documents widespread exposure of young adolescents to movies with brutal, and often sexualized, violence. Given that many of these films were marketed to teens, better oversight of the marketing practices of the film industry may be warranted.

Adolescent↗
PubMed1995

Postoperative lower extremity bypass surveillance: beyond ankle arm blood pressures.

Surveillance is essential to the postoperative follow-up of lower extremity bypass grafts. Early, intermediate, and late thrombosis place the patient's limb at risk, so detection of problems before the graft fails is critical. Because contrast angiography is not routinely performed for surveillance, most vascular surgeons rely on history, physical examination, and noninvasive vascular studies (NVS) to assess perfusion to the lower extremity after bypass grafting. These NVS include ankle/brachial waveforms, blood pressures, and indexes before and after exercise. The purpose of this study is to report our findings with duplex color-flow ultrasonography (DCU) to examine lower extremity bypass grafts. According to our protocol, we monitor lower extremity grafts with ankle/brachial Doppler pressures, analogue waveforms, and lower extremity exercise when possible. These NVS are performed by nurses in the vascular laboratory before the patient is discharged from the hospital, at least twice during the first year, and then annually. DCU is also performed at least two times during the first year and then annually. If the study results are abnormal or if the patient has symptoms, testing is usually repeated. When abnormalities persist contrast angiography may be warranted. We have detected anatomic and hemodynamic changes in lower extremity bypasses by use of our protocol. By adding DCU to ankle/brachial blood pressures, we have identified aneurysmal dilation, diffuse atherosclerosis, focal narrowing, arteriovenous fistulas caused by unligated venous branches, retained venous valves, and disease progression proximal or distal to the graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Vessel Prosthesis↗
PubMed1997

Pituitary, gonadal and adrenal hormones after prolonged residence at extreme altitude in man.

High altitude-induced alterations in pituitary, gonadal and adrenal hormones were studied in (i) eugonadal men from the armed forces who were resident at sea level (SL), (ii) SL residents staying at an altitude of 3542 m for periods ranging from 3 to 12 months (acclimatized lowlanders, ALL), (iii) ALL who stayed at 6300 m for 6 months, (iv) ALL who trekked from 3542 to 5080 m and stayed at an altitude of more than 6300 m in the glacier region for 6 months, and (v) high-altitude natives (HAN) resident at an altitude of 3300-3700 m. Circulating levels of LH, FSH, prolactin, cortisol, testosterone, dihydrotestosterone (DHT) and progesterone in ALL at 3542 m and in HAN were not significantly different (p > 0.05) from the SL control values. When the ALL living at 3542 m trekked to an extreme altitude of 5080 m, their testosterone levels showed a significant decrease (p < 0.01) compared to the preceding altitude values but had returned to SL values when measured after 6 months' continuous stay at 6300 m. As with testosterone, the levels of DHT and oestradiol-17 beta (E2) after prolonged stay at extreme altitude were also not significantly different (p > 0.05) from the SL values. The LH levels after trekking to 5080 m were significantly higher (p < 0.01) than at an altitude of 3542 m, but decreased to levels found at 3542 m or SL after prolonged residence at extreme altitude. Plasma levels of ACTH, prolactin, FSH and cortisol on arrival at 5080 m, and after a 6-month stay at extreme altitude, were not significantly different (p > 0.05) from the SL values. Plasma progesterone levels tended to increase on arrival at 5080 m but a significant increase (p < 0.001) was evident only after a 6-month stay at extreme altitude. These observations suggest that prolonged residence at lower as well as at extreme altitude does not appreciably alter blood levels of pituitary, gonadal or adrenal hormones except for plasma levels of progesterone. The exact mechanism and significance of this increase remains unknown, but may be important in increasing the sensitivity of the hypoxic ventilatory response and activation of haemoglobin synthesis.

Acclimatization↗
PubMed2003

Upper-extremity sarcomas in the United States: analysis of the surveillance, epidemiology, and end results database, 1973-1998.

PURPOSE: Upper-extremity soft-tissue sarcomas are a rare disease with unclear epidemiology and evolving treatment strategies. Our purpose is to evaluate the incidence of upper-extremity soft-tissue sarcomas and the use of adjuvant radiotherapy in this patient population. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, a national population-based database, we identified all cases of primary upper-extremity sarcoma reported to the 9 national SEER registries in the Untied States from 1973 to 1998. RESULTS: Of the 1,286 upper-extremity soft-tissue sarcomas the average incidence rate is 2.2 cases/million/y, which has not changed significantly from 1973 to 1998. Caucasians' average incidence rate is significantly higher than African Americans' (incidence rate ratio [IRR] = 1.3, p =.02); and men are at a significantly higher risk compared with women (IRR = 1.3, p <.01). The use of adjuvant radiotherapy has increased significantly from 17% in 1973 to 47% in 1998 (p <.01). African-Americans, compared with Caucasians, are significantly less likely to receive adjuvant radiotherapy (odds ratio [OR] =.5, p =.01). CONCLUSIONS: The incidence of upper-extremity sarcomas has not changed significantly over the past 3 decades; however, the disease differentially affects the population with higher rates in Caucasians and men. Based on the results of this study the use of adjuvant radiotherapy is increasing but African Americans are less likely than Caucasians to receive this treatment for upper-extremity sarcoma.

Black or African American↗
PubMed2002

Effects of leg and body position on transcutaneous oxygen measurements in healthy subjects and subjects with peripheral artery disease after lower-extremity arterial revascularization: a pilot study.

Transcutaneous oxygen (TcPO(2)) measurements provide a noninvasive, objective determination of the oxygen level at the skin surface. This offers a means of estimating the underlying circulation and tissue oxygenation. The purpose of the pilot study was to measure the TcPO(2) value of the lower extremity of healthy men and women and of patients with peripheral arterial disease (PAD) in 4 different body and leg positions 24 hours after peripheral vascular surgery reconstruction. The specific aim was to determine if lower-extremity TcPO(2) measurements were affected by changes in extremity position in these subject populations. A convenience sample of 4 healthy health care professionals and 4 patients who had peripheral vascular reconstruction surgery 24 hours before the measurements were studied. Subjects were studied in 4 different leg and body positions: supine with legs extended, sitting with legs dependent, a 5 degrees head-up reverse Trendelenburg, and supine with legs elevated 10 in. The Radiometer TCM30 TcPO(2) monitor was used to carry out these measures. Findings revealed a statistically significant difference in TcPO(2) measurements between the 2 groups, with the healthy subjects having a significantly higher TcPO(2) measurement in all extremity positions compared with the revascularized subjects with PAD (P =.02-.05). Significant changes were noted in both the foot temperature (P =.03) and TcPO(2) measurements with extremity positions within the healthy subject group (P =.001). The foot and leg TcPO(2) measurements affect from leg and body position did not reach significance (P =.09) in the subjects with PAD. No change in foot temperature with extremity positioning (P =.42) was noted in the subjects with PAD. This pilot study provides a base in which additional research will be performed with TcPO(2) measurements in both the healthy and revascularized person.

Aged↗
PubMed2000

Effect of trunk rotation and arm position on gross upper extremity adduction strength and muscular activity.

The aim of the experiment was to determine the impact of axial trunk rotation and arm position on upper extremity adduction force and muscle activity. Ten healthy male subjects performed graded maximum voluntary contractions under isometric conditions in seven upper extremity positions and three trunk postures (neutral and 90 degrees left/right rotated) in a simulated manual materials handling task. A custom built lightweight force-measuring device was held between the palmar surfaces of the hands and subjects compressed the lateral surfaces of the device. Muscle activity was recorded bilaterally over the muscle bellies of the anterior deltoid, the long head of the biceps brachii and over the flexor carpi radialis. The activity of the right pectoralis major was also recorded unilaterally. Descriptive, multivariate analysis of variance (MANOVA) and post-hoc Scheffé comparisons were performed on the mean and peak force as well as the EMG [electromyographic] data. Further analysis was performed on the force-EMG relationship at 20% intervals of maximum voluntary contraction (force). Both upper extremity adduction force and EMG were significantly affected by position (p<0.01) but not by trunk rotation. The muscle activity increased and force decreased with flexion of the upper extremity. Pearson correlation coefficients between force and EMG were low. The biceps and flexors were the most active muscles depending upon upper extremity position, and the right pectoralis major muscle activity expressed the highest correlation with force. The present findings confirm earlier hypotheses that upper extremity adduction strength is not significantly affected by trunk rotation.

Adult↗
PubMedDate not supplied

Time to analgesia for patients with painful extremity injuries transported to the emergency department by ambulance.

OBJECTIVE: To measure the time to analgesia for patients with painful, isolated extremity injuries brought to the emergency department (ED) by emergency medical services (EMS). METHODS: A retrospective chart review of all patients presenting with isolated, painful extremity injuries during an 18-month period to a Level 1 trauma center. Medical records were reviewed by diagnostic codes for extremity injuries. INCLUSION CRITERIA: patients 18 years or older transported to the ED by EMS; isolated, painful extremity injuries; received parenteral analgesia in the ED or by EMS. Excluded: multiple trauma patients, interfacility transfers, hemodynamically unstable patients, head-injured patients, intoxicated patients, and patients with mental status changes. Data elements: age, sex, EMS arrival time, EMS medication time, hospital triage time, and ED medication time. All "times to analgesia" were calculated from the EMS arrival time on scene. RESULTS: Extremity injuries were identified in 706 patients. Of these, 104 patients with painful, isolated, extremity injuries met all inclusion criteria. Thirteen (12.5%) of 104 received analgesia by EMS during prehospital care. Ninety-one patients (88%) first received parenteral analgesia in the ED. The mean time to analgesia for EMS treated patients was 23 minutes (95% CI 16.7-30.2). Mean time to analgesia for patients treated in the ED was 113 minutes (95% CI 99.2-128.1). Mean time to analgesia after triage in this group was 75 minutes (95% CI 60.8-89.7). CONCLUSION: In this study, patients received analgesia sooner when administered by EMS during prehospital care. There was a significant time delay after triage for patients first medicated in the ED.

Adult↗
PubMed2004

Hypersaline microbial systems of sabkhas: examples of life's survival in "extreme" conditions.

Life and living systems need several important factors to establish themselves and to have a continued tradition. In this article the nature of the borderline situation for microbial life under heavy salt stress is analyzed and discussed using the example of biofilms and microbial mats of sabkha systems of the Red Sea. Important factors ruling such environments are described, and include the following: (1) Microbial life is better suited for survival in extremely changing and only sporadically water-supplied environments than are larger organisms (including humans). (2) Microbial life shows extremely poikilophilic adaptation patterns to conditions that deviate significantly from conditions normal for life processes on Earth today. (3) Microbial life adapts itself to such extremely changing and only ephemerally supportive conditions by the capacity of extreme changes (a) in morphology (pleomorphy), (b) in metabolic patterns (poikilotrophy), (c) in survival strategies (poikilophily), and (d) by trapping and enclosing all necessary sources of energy matter in an inwardly oriented diffusive cycle. All this is achieved without any serious attempt at escaping from the extreme and extremely changing conditions. Furthermore, these salt swamp systems are geophysiological generators of energy and material reservoirs recycled over a geological time scale. Neither energy nor material is wasted for propagation by spore formation. This capacity is summarized as poikilophilic and poikilotroph behavior of biofilm or microbial mat communities in salt and irradiationstressed environmental conditions of the sabkha or salt desert type. We use mainly cyanobacteria as an example, although other bacteria and even eukaryotic fungi may exhibit the same potential of living and surviving under conditions usually not suitable for life on Earth. It may, however, be postulated that such poikilophilic organisms are the true candidates for life support and survival under conditions never recorded on Planet Earth. Mars and some planets of other suns may be good candidates to search for life under conditions normally not thought to be favorable for the maintenance of life.

Bacteria↗