Pain responses of hospitalized neonates to venipuncture

Neonates' response to pain after venipuncture was studied by observing, recording, and measuring physiological and behavioral responses. The measurement used was the National Individualized Developmental Care Assessment Program (NIDCAP). Data were recorded from a convenience sample of 30 neonates required to have a venipuncture as part of their routine treatment for 20 minutes before and 20 minutes following the procedure by a person certified as reliable in administering the NIDCAP. Both behavioral and physiologic changes were observed. Most of the infants (93 percent) moved abruptly into a hyperalert or crying state in response to venipuncture, skipping several states without transition and showing disorganized behavior. The heart rate, oxygen saturation, and skin color showed significant changes when data recorded just prior to venipuncture were compared to data recorded immediately following the procedure. Nursing implications, including the unit environmental elements, are discussed.

Water vs conventional births: infection rates compared

A comparative study of colonisation of infection rates in mother and baby was carried out. Thirty-two women were screened before delivery for the presence of micro-organisms. Half of this sample delivered in water and half did not. The birthing tub water was sampled before, during and after delivery. The most significant finding was that most women and babies showed no evidence of clinical infection. However, large numbers of Pseudomonas aeruginosa and Acinetobacter sp. were isolated from the water of one delivery; Pseudomonas aeruginosa was isolated initially from the ear and groin of the child and subsequently from multiple sites, including the umbilicus and 'septic skin lesions'. Lack of adherence to the cleaning protocol for water births appeared to be an important factor in this clinical episode.

Post-coma disturbance and post-traumatic amnesia as nonlinear predictors of cognitive outcome following severe closed head injury: findings from the Westmead Head Injury Project

This study sought to identify combinations of early neurological variables which best predict cognitive outcome 12 months after severe head injury. At the time of admission patients were assessed on seven neurological indices. Twelve months later a battery of neuropsychological tests examining recent memory functioning and speed of information processing was administered. Recent memory functioning was best predicted by a combination of post-coma disturbance (PCD; i.e. the duration of post-traumatic amnesia, PTA, minus the duration of coma) and presence of subarachnoid haemorrhage (multiple r = 0.54, p < 0.001). Speed of information processing was best predicted by the duration of PTA (r = 0.35, p < 0.01). However, these conclusions were based on square root transformation of PCD and PTA variables. The success of this transformation in assisting prediction confirms suggestions that the relationship between PTA and cognitive outcome is nonlinear.

TAP1 and TAP2 polymorphism in multiple sclerosis patients

The frequency of TAP1 and TAP2 gene polymorphisms in MS patients was compared with that of a normal population. A significant increase in TAP2-379-VAL homozygosity and TAP2-565-ALA homozygosity was found in HLA-DRB1*1501-DQB1*0602-negative patients.

Increased incidence of intraventricular hemorrhage and developmental delay in cocaine-exposed, very low birth weight infants

This study sought to determine whether very low birth weight (VLBW) infants (< 1500 gm) with fetal cocaine exposure differed from non-cocaine-exposed VLBW infants in incidence of neonatal medical complications and in later developmental outcome. Forty-one cocaine-exposed, VLBW infants, followed in a longitudinal study, were compared with 41 non-cocaine-exposed, VLBW infants of comparable race, social class, age, and incidence of bronchopulmonary dysplasia. Cocaine-exposed infants were identified on the basis of combined findings of maternal and/or infant urine immunoassay and on the basis of maternal self-report. At birth, groups did not differ on medical risk factors except that cocaine-exposed infants had a higher incidence of mild (grades I to II) intraventricular hemorrhage. Cocaine-using women were also more likely to use other drugs, especially alcohol, marijuana, and tobacco. At follow-up, at mean corrected ages of 16.5 +/- 8 months for 30 cocaine-exposed infants and 18.5 +/- 7 months for 37 non-cocaine-exposed infants, standardized assessments of cognitive (Mental Development Index) and motor (Psychomotor Development Index) development were administered. Cocaine-exposed infants had lower mean cognitive (83 +/- 27 vs 91 +/- 19), and motor (85 +/- 25 vs 96 +/- 18) scores; the incidence of developmental delay was significantly higher even after control for the effects of intraventricular hemorrhage and chronologic age. Cocaine-exposed VLBW infants were also more likely to be living with relatives or in foster homes. We conclude that these VLBW, cocaine-exposed infants were at increased risk of intraventricular hemorrhage, were more likely to be placed outside maternal care, and had higher incidences of cognitive and motor delays at follow-up.

Ultrastructural pathology of an inherited lower motor neuron disease of pigs

The ultrastructural features of a recently described inherited lower motor neuron disease were studied in 5 affected pigs. Clinical signs comprised progressive ataxia and paresis of variable severity. Affected pigs, 6, 7, 15, 15, and 19 weeks of age, and 2 unrelated healthy pigs, 9 and 15 weeks of age, were anesthetized and their tissues were fixed by whole body perfusion with mixed aldehydes. From 1 or more affected pigs, samples of cervical and lumbar spinal ventral horn, lateral and ventral spinal columns, dorsal and ventral lumbar spinal nerve roots, 2 peripheral nerves (Nn. phrenicus and fibularis communis), and 2 skeletal muscles (Mm. diaphragma and tibialis cranialis) were examined ultrastructurally. There was widespread degeneration of myelinated axons in peripheral nerves and in lateral and ventral columns of lumbar and cervical segments of spinal cord. Axonal degeneration was present in ventral spinal nerve roots and was absent in dorsal spinal nerve roots sampled at the same lumbar levels. Unmyelinated axons in peripheral nerves and spinal nerve roots were unaffected. In 4 of 5 affected pigs, there were atrophic alpha motor neurons in cervical spinal cord that contained dense, round osmiophilic perikaryal inclusions up to 4 microns in diameter and round swollen mitochondria. Axonal regeneration was present in N. phrenicus of the 19-week-old affected pig that had clinical signs of longest duration (10 weeks). There was no morphologic evidence of axonal degeneration or spinal neuronal atrophy in either control pig. The ultrastructural features of this motor neuron disease distinguish it from other reported progressive spinal neuropathies of pigs.

Frequency of HLA-DPB1 alleles in multiple sclerosis patients from Northern Ireland

Using sequence-specific oligonucleotide probes, no altered distribution in the frequency of HLA-DPB1 alleles was found in multiple sclerosis patients from Northern Ireland. Although present in the controls, linkage disequilibrium between HLA-DPB1*0101 and HLA-DR17 was not found in multiple sclerosis patients.

HLA-DR and DQ DNA genotyping in multiple sclerosis patients in Northern Ireland

DNA from multiple sclerosis (MS) patients and healthy control individuals from the Northern Ireland population, was assessed by restriction fragment length polymorphism (RFLP) analysis to look for disease-associated polymorphisms. HLA-DR and -DQ allogenotyping was performed using a single enzyme (TaqI)/Multiple probe system. The TaqI/DR beta RFLPs correlate well with serologically defined specificities and in addition detect further subtypes of these associated with DQ or Dw specificities. The results confirm an association of MS with DR beta 15 and show a decreased frequency of DR beta 4 in the patients. An increased frequency of DR beta 17 in patients negative for DR beta 15 was also found. There is a decrease in the frequency of the TaqI/DQ beta 3 (TA10 + ve) RFLP and the TaqI/DQ alpha 2LL genotype in the MS patients, these not being associated with DR beta 15. In addition RFLP analysis of the DPA1 and DPB1 genes reveals an MspI/DP beta 3.0-kb fragment which occurs at a higher frequency in the patients than in the controls.

Effect of neural activity on skeletal muscle phosphoproteins

A number of phosphoproteins were found in the soluble fraction of rat skeletal muscle by two-dimensional polyacrylamide gel electrophoresis (PAGE). The pattern of some of these phosphoproteins differed in fast (extensor digitorum longus, EDL) or slow (soleus) muscles, was dependent on normal innervation, and was altered with denervation. In order to determine if the pattern was maintained by electrical activity or trophic factors, we compared the effect of electrical block by local neural application of tetrodotoxin with the effect of complete nerve section. Both methods produced similar alterations in phosphoproteins, indicating that the pattern is dependent on nerve activity, not trophic factors. Such phosphoproteins are possible mediators of neural activity on gene expression.

The Maine State Patient Education Forum: networking system for a rural area

Patient education councils are growing and prospering. The Maine State Patient Education Forum is one such council which has gone through a continuing developmental process to meet needs of patient educators in Maine. Involving many organizations and individuals who do patient education, having a clear direction and a common locus, scheduling regular meetings, and participating in national networking have all been ways to vitalize and strengthen the council. Maine as a rural state has found the forum to be a dynamic model to motivate patient educators to maintain flexibility and acquire new concepts so they can continue to provide high quality patient education services.

Succinylcholine-assisted intubations in prehospital care

Although endotracheal intubation is considered the optimal technique for airway management in critically ill patients, performance of this task in the prehospital setting is at times difficult due to increased masseter muscle tone, vocal cord spasm, or patient combativeness. Use of short-acting paralyzing agents by paramedics to facilitate intubation in these situations is an uncommon practice. We report the recent experience of an emergency medical service system that has used succinylcholine (SUX) for more than ten years. We reviewed prehospital patient intubations for two years; 215 patients were intubated by paramedics without the use of SUX and 95 patients were intubated with the use of SUX. The patient group intubated with SUX was characterized by a greater percentage of women (48% vs 35%; P less than .05), a higher mean Glasgow Coma Scale score (8.6 vs 3.4), fewer intubations for cardiac arrest (3% vs 81%), and more hospital survivors (58% vs 24%; P less than .005). The groups were not different with respect to mean age or frequency of trauma. Paramedics chose to use SUX in 69% of nonarrested patients requiring intubation. SUX-assisted intubation was used most often for the indications of airway protection and respiratory distress. Review of hospital records showed no difference between the groups for frequency of either aspiration pneumonia or mechanical ventilation in patients surviving to hospital admission. No patient receiving SUX required emergency cricothyrotomy, nor was esophageal intubation noted in either group. Succinylcholine-assisted intubation was used safely and selectively by the paramedics in this EMS system to permit airway control and ventilation of patients with more difficult intubations.

Changes in pressor hormone concentrations in association with coronary artery surgery. Renin and vasopressin responses

In 10 patients undergoing routine coronary artery surgery, plasma renin activity and vasopressin concentration were measured at intervals before the induction of anaesthesia, and for 6 h after bypass. In three patients plasma renin activity was increased, but the increases followed no particular pattern. Vasopressin concentrations increased in all 10 patients, but the changes were not significantly correlated with the postoperative arterial hypertension that was seen in seven of the patients.

Improved methodology for the production of monoclonal antibodies against parasites

A modification of the standard fusion methodology is described which results in greatly increased yields of monoclonal antibodies against certain organ-specific parasites. Several fusions were carried out using mice infected with Schistosoma mansoni or Nematospiroides dubius, using B lymphocytes harvested from either the spleen or the mesenteric lymph nodes. Results indicated a greatly improved yield of positive clones using the lymph nodes as a source of B cells for fusion. A 7-fold increase in the number of positive clones was seen with N. dubius injections, while S. mansoni fusions showed a 2-fold increase.

Catalytic site of calmodulin-dependent protein phosphatase from bovine brain resides in subunit A

The calmodulin-dependent protein phosphatase from bovine brain is composed of two subunits: subunit A, Mr 60,000, and subunit B, Mr 16,500. Using in vitro immunization techniques, we have produced a monoclonal antibody specific for the phosphatase. The antibody was immobilized to Sepharose 4B to prepare an immunoabsorbent column, which was used to purify the enzyme. Phosphatase isolated from the column showed a polypeptide with Mr 60,000, equivalent to subunit A, which showed calmodulin-dependent phosphatase activity. Subunit B was not obtained from the column. Limited trypsin digestion stimulated phosphatase activity, yielding polypeptides of Mr 59,000, 43,000, and 16,000; the phosphatase activity after trypsin digestion was calmodulin independent. Chromatography of trypsin-treated phosphatase on an immunoaffinity column yielded two proteins, Mr 59,000 and 43,000, that were catalytically active and calmodulin independent. In a separate experiment, the two subunits of the phosphatase were separated by gel filtration in 6 M urea. Subunit A isolated from the filtration column showed little or no activity in the presence of Ca2+ and calmodulin, but it showed calmodulin-dependent phosphatase activity in the presence of 0.8 mM Mn2+. Subunit B was catalytically inactive. Collectively, these results indicate that subunit A and its proteolytic fragment contain the catalytic site and the antigenic determinant for the monoclonal antibody.