Vacuolation of seminiferous tubule cells mimicking intratubular germ cell neoplasia (ITGCN).
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Adult↗
Biomedical subjects
E Bruce
Publications and source records attributed to E Bruce.
Management of mutual health organizations in Ghana.
OBJECTIVE: Mutual Health Organizations (MHO) emerged in Ghana in the mid-1990s. The organizational structure and financial management of private and public MHO hold important lessons for the development of national health insurance in Ghana, but there is little evidence to date on their features. This paper aims at filling this data gap, and at making recommendations to Ghanaian authorities on how to stimulate the success of MHO. METHODS: Survey among 45 private and public MHO in Ghana in 2004-2005, asking questions on their structure, financial management and financial position. RESULTS: Private MHO had more autonomy in setting premiums and benefit packages, and had higher community participation in meetings than public MHO. MHO in general had few measures in place to control moral hazard and reduce adverse selection, but more measures to control fraud and prevent cost escalation. The vast majority of schemes were managed by formally trained and paid staff. The financial results varied considerably. CONCLUSIONS: Ghanaian authorities regulate the newly established public MHO, but may do good by leaving them a certain level of autonomy in decision-making and secure community participation. The financial management of MHO is suboptimal, which indicates the need for technical assistance.
Community Participation↗
Effect of dislodging techniques on foliar residue determination for agricultural crops.
The Agricultural Reentry Task Force (ARTF) conducted a study to determine whether different dislodgeable foliar residue (DFR) techniques had any effect on the amount of residues dislodged from the leaves of vegetable crops. Four previously employed techniques were evaluated with two chemicals (carbaryl and methomyl) on two crops (cabbage and lettuce). Carbaryl, a moderately water-soluble chemical, was applied at a rate of 2.0 lbs active ingredient/acre (lb ai/A) while methomyl, a highly water soluble chemical, was applied at a rate of 0.9 lb ai/A. One day after application, leaf punches were collected and the residues were dislodged following one of four techniques that differed in the number of dislodgings per sample, the duration of dislodging, the solution volume, and/or the type of solution used. The results indicated that three of the techniques gave similar results, whereas a fourth gave marginally lower results.
Carbaryl↗
Using the worldwide web to improve children's pain care.
AIM: This paper describes a three-year project, the aims of which were to disseminate information regarding the assessment and management of children's pain, to reach consensus on the essential elements of pain assessment for children and to track nurses' perceived changes in pain assessment and management practices in hospital settings over time. BACKGROUND: Despite the availability of research, guidelines and standards, paediatric nurses inconsistently practice evidence-based pain management. PROJECT METHODS: Nurses attending the 5th International Symposium on Paediatric Pain were invited to a workshop to discuss best practices and consider ways to share information regarding the assessment and management of children's pain. A website was designed and participants provided hospital guidelines, exchanged information via the Internet and completed periodic surveys. CONCLUSION: Web-based resources were positively received. Consensus regarding the essential elements of pain management was achieved, but nurses identified organizational and resource restraints as barriers to achieving best practices. Surveys identified perceived increases in some hospital and ward level resources and activities to improve children's pain care. Sharing of information related to children's pain management and benchmarking of practice should be encouraged. Consensus building and networking may facilitate change, but organizational commitment is also required for successful implementation of new practices.
Consensus↗
Dynamic cardiorespiratory interaction during head-up tilt-mediated presyncope.
In 28 healthy adults, we compared the dynamic interaction between respiration and cerebral autoregulation in 2 groups of subjects: those who did and did not develop presyncopal symptoms during 70 degrees passive head-up tilt (HUT), i.e., nonpresyncopal (23 subjects) and presyncopal (5 subjects). Airflow, CO2, cerebral blood flow velocity (CBF), ECG, and blood pressure (BP) were recorded. To determine whether influences of mean BP (MBP) and systolic SP (SBP) on CBF were altered in presyncopal subjects, coherencies and transfer functions between these variables and mean and peak CBF (CBFm and CBFp) were estimated. To determine the influence of end-tidal CO2 (ETco2) on CBF, the relative CO2 reactivity (%change in CBFm per mmHg change in ETco2) was calculated. We found that in presyncopal subjects before symptoms during HUT, coherence between SBP and CBFp was higher (P=0.02) and gains of transfer functions between BP (MBP and SBP) and CBFm were larger (MBP, P=0.01; SBP, P=0.01) in the respiratory frequency region. In the last 3 min before presyncope, presyncopals had a reduced relative CO2 reactivity (P=0.005), likely a consequence of the larger decrease in ETco2. We hypothesize that the CO2-mediated increase in resistance attenuates autoregulation such that the relationship between systemic and cerebral hemodynamics is enhanced. Our results suggest that an altered cardiorespiratory interaction involving cerebral hemodynamics may contribute in the cascade of events during tilt that culminate in unexplained syncope.
Adult↗
Stay calm with PROM.
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Delivery, Obstetric↗
Reduced long-term respiratory morbidity after treatment of respiratory syncytial virus bronchiolitis with ribavirin in previously healthy infants: a preliminary report.
Previously healthy infants less than 6 months of age with severe respiratory syncytial virus bronchiolitis who required hospitalization were identified from hospital records. Infants had been treated either conservatively (control group, n = 19) or with ribavirin added to conservative management (study group, n = 22). All infants underwent a 1-year follow-up after the initial illness. There was a significant reduction in the prevalence of reactive airway disease in the group treated with ribavirin (P < 0.05) compared with the control group, both in terms of the proportion of patients developing airway reactivity (59% vs. 89%) and the number of episodes of reactive airway disease (31 vs. 70). Our data suggest that ribavirin reduces the prevalence of airway reactivity.
Albuterol↗
Use of amplitude-modulated breathing for assessment of cardiorespiratory frequency response within subrespiratory frequencies.
We present a new technique which uses amplitude-modulated breathing patterns to obtain estimates of frequency response between respiration and heart rate within subrespiratory frequencies. Frequency response between respiration and heart rate has been previously estimated using broadband respiration and metronomic breathing. However, the estimates obtained using these techniques show low coherence between respiration and heart rate within the subrespiratory frequencies (< 0.12-0.15 Hz). The advantages of amplitude-modulated breathing are: enhancement in the degree of perturbation within subrespiratory frequencies as indicated by relatively higher coherencies between respiration and heart rate (approximately equal to 0.7), and the subjects do not have to breathe at very low breathing frequencies or resort to breath holds. Use of a squared sine wave carrier modulated by sinusoidal functions enabled us to obtain energy distributions at subrespiratory frequencies without using demodulation. Results obtained at eight subrespiratory frequencies from ten subjects show that the new technique is easy to implement and produces relatively higher coherence between respiration and heart rate. The advantage of the new technique in terms of enhancing the level of perturbations within subrespiratory frequencies is particularly important, because it is in this frequency range that the interpretation of variability in heart rate in terms of autonomic origins is incompletely understood and is confounded by respiratory interactions.
Adult↗
Construction of a gene encoding the insect bactericidal protein attacin. Studies on its expression in Escherichia coli.
Attacin, a bactericidal small protein is produced by the giant silk moth Hyalophora cecropia. This paper deals with our efforts to clone the attacin cDNA in a bacterial vector to express it in Escherichia coli and produce the protein in sufficient amount, for further studies. We chose two inducible expression vector/bacterial cell systems: pPL-lambda/N99cI+ cells which is able to be induced by nalidixic acid, and pET3d/BL21(DE3) cells carrying a T7 RNA polymerase gene which is IPTG-inducible. After cloning in the pPL-lambda system and under no addition of the inducer, isolated transformants carried this plasmid with at least 2 concurrent deletions that drastically affected attacin expression, even though attacin gene seems to be intact as deduced by its PCR amplification. It was concluded that basal attacin expression occurred in this system and bacterial growth was limited. Plasmid deletions may have emerged by selection pressure as a way to avoid bactericidal expression and allow bacteria survival. The second cloning attempt was done in pET3d vector/BL21 cells, that should not express the cloned sequence (they lack T7 RNA polymerase gene). Transformed BL21 cells gave 3 recombinant plasmids, 2 of them presented a C deletion that generated an early stop signal in the attacin coding region. The third clone, pET-ATT18, carrying an intact gene, was transferred to BL21(DE3)-IPTG inducible cells in order to be expressed. Attacin was undetectable in stained gels or by Western blot analysis. However, expression was visualized in grown cells after 30 min of IPTG induction and 5 min of [35S]-methionine labeling, as a 22.5 kDa protein band by using gel electrophoresis and fluorography. This low level of expression drastically affected bacterial growth. Considering that attacin has no lytic activity, these results suggest that this molecule should block bacterial growth directly at the cytoplasm by an unknown mechanism, since no signal peptide coding sequence was incorporated in this gene construction, precluding periplasmic or external destination of this protein.
Anti-Bacterial Agents↗
Decreased inotropic but relatively preserved relaxation response to cyclic adenosine monophosphate-dependent agents in myopathic human myocardium.
BACKGROUND: Increased intracellular concentrations of cyclic adenosine monophosphate (AMP) stimulate a positive inotropic and lusitropic response in healthy myocardial tissue. Heart failure results in an attenuated inotropic response to cyclic AMP-dependent agents. This study compares the inotropic versus relaxation response to cyclic AMP-dependent and cyclic AMP-independent agents in myocardium from patients with end-stage heart failure and control patients without heart failure. METHODS AND RESULTS: Fifty-four control and 59 myopathic human ventricular trabeculae, 1 mm or less in diameter were placed in physiologic saline, 2.5 mM Ca2+, and stretched to the length at which maximal isometric force developed at 30 degrees C, 0.33 Hz. Dose-response curves plotted as percentage change from baseline versus concentration of drug were determined for acetylstrophanthidin, isoproterenol, isobutylmethylxanthine, and milrinone. Acetylstrophanthidin, a cyclic AMP-independent agent, showed similar increases in peak tension relative to baseline over the entire dose range tested for both control and myopathic heart muscle; its effect on relaxation of control and failing cardiac muscle was equivalent over the dose range tested. In contrast, the inotropic actions of the cyclic AMP-dependent agents, isoproterenol and the phosphodiesterase inhibitors, were significantly decreased in myopathic muscle compared with control muscle, but effects on relaxation in the control and myopathic groups remained relatively preserved. CONCLUSIONS: A relatively preserved relaxant effect is associated with the cyclic AMP-dependent agents, despite significant diminution of their inotropic effects. Thus, in advanced heart failure, patients may continue to benefit from the lusitropic effects of the cyclic AMP-dependent agents, even when the inotropic effects of these agents are severely attenuated.
1-Methyl-3-isobutylxanthine↗
Myofascial pain syndrome: early recognition and comprehensive management.
Fewer conditions in clinical practice have generated more controversy and debate than those that cause musculoskeletal pain and dysfunction. The term myofascial pain refers to a syndrome of musculoskeletal discomfort. Myofascial pain is a significant physical disorder responsible for long term disability. Early diagnosis of myofascial pain syndrome and circumspect treatment without using narcotic and non-narcotic analgesics results in successful outcomes. The goal of treatment should always be function oriented, set at the beginning of a treatment program, and modified at periodic intervals. Concurrent psychosocial stressors in the home and at work should be identified and treated appropriately.
Diagnosis, Differential↗
Thrombosis of the portal vein in eleven dogs.
Case records from the small animal necropsy service of the University of Pennsylvania (Philadelphia, PA) from January 1981 through August 1990 were searched for reports of animals with grossly visible portal vein thrombi. Eleven dogs identified from their case materials as having portal vein thrombosis were used for this study. The age of the dogs ranged from 2 to 13 years, and there were five spayed females and six males--four intact and two castrated. Seven breeds were represented (Lhasa Apso, German Wire haired Pointer, Shetland Sheepdog, Dalmatian, Irish Wolfhound, Old English Sheepdog, and Siberian Husky), and the remaining four cases were identified as mixed breeds. The weight of the dogs ranged from 7.7 to 50 kg, and most of them were considered overweight. Dogs with microthrombi and tumor emboli in the portal vein were excluded. No age, sex, or breed predisposition was found. Thrombi were also detected in the pulmonary arteries in five of the dogs and both the pulmonary arteries and aorta in one dog. The portal thrombi extended into the mesenteric veins in three dogs, resulting in infarction of the jejunum. One of these dogs and two other dogs had chronic occlusion of the portal vein, with the formation of secondary portosystemic shunts. Conditions also present in dogs with portal vein thrombi included pancreatic necrosis (four dogs), peritonitis (two dogs), distant neoplasia (three dogs), and therapy with steroids (ten dogs).
Animals↗
Cardiac contusion in patients wearing seat belts.
The incidence of myocardial contusion in patients wearing seat belts and requiring admission to hospital after road traffic accidents was examined. The criteria used for diagnosing contusion were serial electrocardiograms (ECGs) and estimation of CK-MB isoenzymes using the Isomune-CK (Roche) kit. Nine of the 14 patients (64 per cent) showed evidence of myocardial contusion. We suggest long-term studies to establish the true incidence among patients wearing seat belts.
Accidents, Traffic↗
Near drowning: a successful treatment.
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Child↗
Chest wall shape during forced expiratory maneuvers.
Abdominothoracic shape during the forced vital capacity was studied in 10 normal subjects using magnetometers to monitor anteroposterior diameters at the level of the manubrium, xiphoid, and epigastrium, lateral rib cage diameter at the xiphoid level, and vertical motion of the rib cage. Thoracic cross-sectional area change at the xiphoid level was found to lag lung volume change, due to an early paradoxical increase (or lack of change), of lower anteroposterior rib cage diameter. To the extent that the resulting rib cage deformation can influence the pleural pressure gradient, the observed shape changes provide a potential mechanism for early preferential emptying of the upper lobes and later more homogeneous emptying in forced, compared to slow, vital capacity maneuvers. Comparisons of shape changes during Valsalva and abdominal expiratory ("expulsive") maneuvers suggest that lower rib cage deformation may not simply be due to the action of rib cage muscles affecting predominantly the lateral rib cage but rather the results of diaphragmatic activity and the influence of abdominal shape on the lower rib cage.
Adult↗
Breathing responses of unanesthetized man and guinea pigs to increased transrespiratory pressure.
We compared the breathing responses of unanesthetized men and guinea pigs to externally imposed shifts in lung volume produced by steady pressures applied to the body surface while the mouth remained near atmospheric pressure. Lung inflation caused no consistent or significant changes either in frequency or end-tidal CO2 in the three men. In contrast, during lung inflation the guinea pigs breathed at low frequencies and smaller tidal volumes and showed consistent increases in arterial PCO2 lasting up to 10 min. The changes seen immediately on application of pressure, namely apneic periods followed by breathing in which inspiratory duration was shortened while expiratory duration was substantially increased, indicates that conscious guinea pigs have active inflation reflexes. We concluded that the reflex responses rather than mechanical factors probably account for the underventilation in the guinea pigs and that guinea pigs are not nearly as well equipped as is man to defend gas exchange in the face of nonmetabolic shifts in lung volume.
Animals↗
Vocal cord closure. A cause of upper airway obstruction during controlled ventilation.
Studies of vocal cord function were undertaken in a quadriplegic patient requiring ventilatory assistance, and in 2 normal subjects during controlled ventilation in a tank-type respirator. When the patient and the normal subjects relaxed and made no conscious effort to assist the respirator, the vocal cords were observed to close during inspiration and a large pressure gradient (12 to 19 cm H2O) developed across the cords. When the subjects made a slight inspiratory effort ("assist" mode), the cords opened widely during inspiration. There were large increases in flow and tidal volume in the "assist" mode compared with passive ventilation. Measurements of transdiaphragmatic pressure and esophageal pressure showed that these variables did not increase with the slight assist. Thus, increase in ventilation during the "assist" mode appeared to be due to alleviation of inspiratory obstruction at the level of the vocal cords. The same phenomenon was observed in the patient during phrenic nerve pacing. A pacemaker was designed to be triggered by the electromyographic impulse from an accessory muscle of respiration. In this manner, vocal cord opening could be coordinated with the mechanical assist given by the phrenic nerve pacer.
Adult↗
Role of infection in the death of children with acute lymphoblastic leukaemia.
Twenty-four consecutive deaths from a total of 70 children receiving treatment for acute lymphoblastic leukaemia (ALL) have been reviewed. An attempt has been made to ascribe the cause of death to either infection, haemorrhage, the leukaemia itself, or a combination of these factors. No child was free of infection at death. Infection, with or without haemorrhage, was responsible for the deaths of all 15 children whose leukaemia had not relapsed. Although infection was present at death in all 9 children whose leukaemia had relapsed, the leukaemia process itself was also a major contributing factor. Viruses were associated with death in many of the children and may be emerging as important pathogens in children with ALL. Familiarity with a protocol may be an important factor in the prevention of fatal infections in such children. Centralization of treatment is necessary if this expertise is to be acquired.
Acute Disease↗