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Biomedical subjects

D J Hatch

Publications and source records attributed to D J Hatch.

At least 19 recordsLinked to original sources

The effect of cutting, mulching and applications of farmyard manure on nitrogen fixation in a red clover/grass sward.

In organic farming, maximising the amount of nitrogen (N) which is fixed and retained within the soil is of paramount importance for the yield of the following crop. The aim of this study was to establish the extent to which increased soil fertility, farmyard manure (FYM) applications and/or mulching, could adversely affect fixation. At two sites, situated in the South West (SW) and North East (NE) of England, N(2) fixation was estimated in 'organically' managed red clover/grass plots, both with and without green manure (i.e. surface mulched) and/or the addition of FYM. The FYM was incorporated into the seedbeds at both sites in autumn 2002 at the rate of 170 kg total Nha(-1), as either well-composted (SW site), or not actively-composted (NE site) manures. The same FYM application rate was repeated as top-dressings to both sites in autumn 2003. The plots were cut three or four times each year over two growing seasons. In the first harvest year (2003), incorporation of FYM had beneficial effects of increasing dry matter and N yields significantly at the first cut, but there were no significant differences in subsequent cuts. The same pattern was found in the second harvest year (2004) after the top dressings of FYM, suggesting that most of the N in both types of FYM was in recalcitrant forms. Over the two growing seasons, mulching did not affect red clover/grass dry matter or N yields, but did reduce the proportion of N(2) fixed, by up to 60 kg Nha(-1) when compared with plots from which the clover/grass herbage was cut and removed. Thus, the gain in N from FYM or green manure tended to be offset by a similar reduction in N(2) fixation. These results demonstrate the close association between the availability of soil N and the feed-back system which operates on N(2) fixation by red clover.

Agriculture↗

Quality in paediatric anaesthesia: a pilot study of interdepartmental peer review.

A pilot to assess a process of interdepartmental peer review of paediatric anaesthetic departments in the United Kingdom was undertaken. Departments were assessed in relation to the standards which should characterise anaesthetic departments throughout the country. Examples of good practice and areas for further development were identified. Peer review visits were conducted by teams which included medical and non-medical members. The importance of the inclusion of lay people in such visits is being increasingly recognised. All of those who participated in the process felt their time had been usefully spent, and they were enthusiastic for the process to continue.

Anesthesia↗

Inflammatory pain and hypersensitivity are selectively reversed by epidural bupivacaine and are developmentally regulated.

BACKGROUND: Low doses of local anesthetics applied to the young rat spinal cord in vitro have been shown to inhibit C-fiber-evoked responses. The aim of this work was to investigate whether such low doses applied epidurally selectively reduce nociceptive responses in vivo and to investigate the influence of postnatal development on such local anesthetic actions. METHODS: Three groups of rat pups aged 3, 10, and 21 days were studied. The threshold of the flexion withdrawal reflex to mechanical stimulation was determined in the hind limb at each age. Inflammatory pain was induced in the right hind limb with 2% carrageenan, causing a reduction in the sensory threshold on that side. The difference in threshold between the two sides represents inflammatory hypersensitivity. The effect of low-dose epidural bupivacaine on sensory thresholds and thus the induced hypersensitivity was also determined for each age group. RESULTS: Inflammatory hypersensitivity was selectively attenuated by very low doses of bupivacaine (concentration range. 0.004-0.0625%), which did not affect the sensory threshold in the contralateral uninflamed limb. This effect was also age-related, with younger rats being more sensitive than older rats. CONCLUSIONS: The effects of epidural bupivacaine in the infant rat are developmentally regulated. Lower doses have a selective analgesic effect that decreases with increasing postnatal age.

Aging↗

Preliminary experience with the Doppler ultrasound guided vascular access needle in paediatric patients.

Percutaneous cannulation of the internal jugular vein (IJV) in infants and children may be technically difficult and can lead to complications. Various techniques exist to achieve successful cannulation and to reduce the rate of complications. We report the use of the Doppler ultrasound guided vascular access needle (the SMART needle) for IJV cannulation in 10 infants and young children (mean age 3.7 months) weighing less than 10 kg (mean weight 5.5 kg) who were to undergo cardiac surgery at Great Ormond Street Hospital for Children. Successful cannulation was achieved in six out of 10 patients with haematoma complicating the procedure in two patients. We believe this is the first reported use of this device for cannulation of the IJV in this patient group.

Body Weight↗

Development of a nurse-led sedation service for paediatric magnetic resonance imaging.

BACKGROUND: Children generally lie still enough for magnetic resonance imaging (MRI) only if they are asleep, either under sedation, which is deeper than conscious sedation, or under anaesthesia. Anaesthesia resources, however, are limited, and non-anaesthetists must use sedation frequently. Demand for MRI has increased and the failure of our sedation regimen led to an impractical demand for anaesthesia and unacceptable waiting times for scanning. We have therefore developed a nurse-led sedation service in a designated unit next to the scanner. This study assessed the safety and efficacy of this approach. METHODS: Children who required MRI were sedated in the unit by designated sedationist nurses, who used an oral drug regimen (according to weight and age from conception: weight <5 kg, 50 mg/kg chloral hydrate; 5-10 kg, 100 mg/kg chloral hydrate; 10-20 kg, 1 mg/kg temazepam plus 0.25 mg/kg droperidol; >20 kg temazepam and droperidol as directed by radiologist, maximum doses 20 mg and 5 mg respectively). Nurses checked patients for their suitability, charted and administered the drugs according to a protocol, and monitored the children throughout the sedation. We prospectively audited failure and complications of sedation. FINDINGS: During the 30 month study, there were 1155 sedations. 61 (5%) were unsuccessful, and there were no adverse events relating to the airway or breathing. After scanning had finished all children, in response to gently pinching the nose, could open their mouths to maintain their airway. INTERPRETATION: This study suggests that it is possible to have a nurse-led sedation service for MRI of children that is both successful and safe.

Anesthesia↗

Circulating platelet-neutrophil complexes represent a subpopulation of activated neutrophils primed for adhesion, phagocytosis and intracellular killing.

Platelets play a prominent role in linking the processes of inflammation, haemostasis and thrombosis. Recent studies have shown that platelets form heterotypic aggregates with leucocytes via platelet CD62P and leucocyte beta2 integrins. These interactions have been observed in vitro in blood taken from healthy volunteers and in clinical conditions in which thrombosis and inflammation are prominent. This study investigated the properties of platelet-neutrophil complexes (PNCs) in anticoagulated whole blood. At rest, neutrophils in PNCs exhibit a significantly more activated adhesion molecule profile than free neutrophils with increased CD11b expression and activation (increased binding of the CD11b/CD18 'activation reporter' monoclonal antibody 24) and decreased CD62L expression. In addition, neutrophils in PNCs phagocytosed significantly more Neisseria meningitidis and produced more toxic oxygen metabolites than free neutrophils. Stimulation with the platelet agonist adenosine diphosphate (ADP) led to further increases in CD11b expression and activation, loss of CD62L as well as increased phagocytosis and toxic oxygen metabolite production throughout the whole neutrophil population. When these experiments were repeated with the CD62P blocking antibody G1 the effects were inhibited to a variable extent, dependent upon the parameter under investigation. These results indicate that both soluble and contact-dependent factors contribute to platelet-mediated neutrophil activation. Platelet neutrophil complexes represent a large subpopulation of neutrophils with a more activated adhesion molecule profile, and a greater capacity for phagocytosis and toxic oxygen metabolite production. This study provides further support for a role for PNCs in both health and disease.

Blood Platelets↗

Sensory hyperinnervation after neonatal skin wounding: effect of bupivacaine sciatic nerve block.

The response to tissue injury includes sensitization of peripheral nociceptors and central neuronal pathways leading to acute clinical and inflammatory pain. A further response is sprouting of sensory nerve terminals in the region of skin damage. This hyperinnervation response is particularly intense in neonates compared with adults. In this study, we tested the effect of regional nerve block at the time of injury on skin hyperinnervation. Anaesthetized newborn rat pups were treated with percutaneous sciatic nerve block injections of 0.25% bupivacaine 25 microliters followed by a localized hindpaw skin wound. Cutaneous innervation was studied by image analysis of immunostained skin sections, 7 days after wounding, and sensory thresholds were assessed using von Frey hairs. The results showed that both hyperinnervation and hypersensitivity were not significantly altered by the application of a regional nerve block at the time of injury. This suggests that regional analgesia, used commonly in clinical practice, is unlikely to prevent the hyperinnervation that follows skin wounding.

Anesthetics, Local↗

Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices.

OBJECTIVE: Acute hypoxemic respiratory failure (AHRF) is a common reason for emergency pediatric intensive care. An objective assessment of disease severity from acute physiological parameters would be of value in clinical practice and in the design of clinical trials. We hypothesised that there was a difference in the best early respiratory indices in those who died compared with those who survived. DESIGN: A prospective observational study of 118 consecutive AHRF admissions with data analysis incorporating all blood gases. SETTING: A pediatric intensive care unit in a national children's hospital. INTERVENTIONS: None. RESULTS: Mortality was 26/118, 22% (95 % confidence interval 18-26%). There were no significant differences in the best alveolar-arterial oxygen tension gradient (A-aDO2, torr), oxygenation index (OI), ventilation index (VI), or PaO2/FIO2 during the first 2 days of intensive care between the survivors and non-survivors. Only the mean airway pressure (MAP, cm H2O) used for supportive care was significantly different on days 0 and 1 (p < 0.05) with higher pressure being used in non-survivors. Multiple logistic regression analysis did not identify any gas exchange or ventilator parameter independently associated with mortality. Rather, all deaths were associated with coincident pathology or multi-organ system failure, or perceived treatment futility due to pre-existing diagnoses instead of unsupportable respiratory failure. When using previously published predictors of outcome (VI > 40 and OI > 40; A-aDO2 > 450 for 24 h; A-aDO2 > 470 or MAP > 23; or A-aDO2 > 420) the risk of mortality was overestimated significantly in the current population. CONCLUSION: The original hypothesis was refuted. It appears that the outcome of AHRF in present day pediatric critical care is principally related to the severity of associated pathology and now no longer solely to the severity of respiratory failure. Further studies in larger series are needed to confirm these findings.

Acute Disease↗

Investigation of platelet-neutrophil interactions in whole blood by flow cytometry.

Evidence is increasing that platelets can initiate and propagate inflammatory processes by interacting with leucocytes and the vascular endothelium. Platelets have been shown to bind to neutrophils, existing as platelet/neutrophil complexes (PNC) within the circulation. We describe a simple flow cytometric method for assessing and investigating platelet interactions with neutrophils in small volumes of whole blood. Twenty-five percent (sd 6%) of circulating neutrophils from healthy adults were associated with platelets. Formation of these platelet-neutrophil complexes was CD62P (P-selectin) and divalent cation dependent. Platelet activation (with ADP or thrombin) caused a rapid and sustained rise in %PNC which differed from the pattern of free platelet activation as assessed by CD62P expression. F-met-leu-phe induced neutrophil activation but did not increase the percentage PNC. Platelet activation also caused increased neutrophil CD11b/CD18 expression which was most marked on neutrophils complexed with platelets. This straightforward technique is simple, reproducible, and allows assessment of platelet-neutrophil interactions and activation of neutrophils. It may also provide a method for estimating platelet activation in whole blood.

Adult↗