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Wohlauer M, Moore E, Harr J, Eun J, Fragoso M, Banerjee A, Silliman CC. Cross-transfusion of postshock mesenteric lymph provokes acute lung injury. J Surg Res 2011; 170:314-8. [PMID: 21550053 PMCID: PMC3154326 DOI: 10.1016/j.jss.2011.03.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/24/2011] [Accepted: 03/17/2011] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Substantial investigation has implicated mesenteric lymph as the mechanistic link between gut ischemia/reperfusion (I/R) and distant organ injury. Specifically, lymph diversion prevents acute lung injury (ALI) in vitro, and bioactive lipids and proteins isolated from postshock mesenteric lymph (PSML) maintain bioactivity in vitro. However, Koch's postulates remain to be satisfied via direct cross-transfusion into a naïve animal. We therefore hypothesized that real time cross-transfusion of postshock mesenteric lymph provokes acute lung injury. METHODS One set of Sprague-Dawley rats (lymph donors) was anesthetized, with the mesenteric lymph ducts cannulated and exteriorized to drain freely into a siliconates plastic cup; concurrently, a second group of rats ( lymph recipients) was anesthetized, with a cannula inserted into the animal's right internal jugular vein. Blood was removed from the donor rats to induce hemorrhagic shock (MAP of 35 mmHg × 45 min). The recipient rats were positioned 10 cm below the plastic cup, which emptied into the jugular vein cannula. Thus, mesenteric lymph from the shocked donor rat was delivered to the recipient rat at the rate generated during shock and the subsequent 3 h of resuscitation. RESULTS Neutrophil (PMN) accumulation in the lungs was substantially elevated in the postshock lymph cross-transfusion group compared to both sham lymph cross-transfusion and instrumented control (MPO: 9.42 ± 1.55 versus 2.81 ± 0.82 U/mg lung tissue in postshock versus sham lymph cross-transfusion, n = 6 in each group, P = 0.02). Additionally, cross-transfusion of PSML induced oxidative stress in the lung (0.21 ± 0.03 versus 0.10 ± 0.01 micromoles MDA per mg lung tissue in lymph cross-transfusion versus instrumented control, n = 6 in each group, P = 0.046). Furthermore, transfusion of PSML provoked lung injury (BAL protein 0.77 ± 0.18 versus 0.15 ± 0.02 mg/mL protein in BALF, postshock versus sham lymph cross-transfusion, n = 6 in each group, P = 0.004). CONCLUSION Cross-transfusion of PSML into a naïve animal leads to PMN accumulation and provokes ALI. These data provide evidence that postshock agents released into mesenteric lymph are capable of provoking distant organ injury.
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Affiliation(s)
- M. Wohlauer
- Department of Surgery, University of Colorado Denver, Denver, CO
| | - E. Moore
- Department of Surgery, University of Colorado Denver, Denver, CO
- Department of Surgery, Denver Health Medical Center, Denver, CO
| | - J. Harr
- Department of Surgery, University of Colorado Denver, Denver, CO
| | - J. Eun
- Department of Surgery, University of Colorado Denver, Denver, CO
| | - M. Fragoso
- Department of Surgery, University of Colorado Denver, Denver, CO
| | - A. Banerjee
- Department of Surgery, Denver Health Medical Center, Denver, CO
| | - CC Silliman
- Department of Pediatrics, University of Colorado Denver, Denver, CO
- Research Department, Bonfils Blood Center, Denver, CO
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Lee L, Kelher M, Moore E, Silliman C, Harr J, Benson D, Banerjee A. Hypertonic Saline Inhibits Leukotriene B4 And Arachidonic Acid Priming Of The Neutrophil Oxidase. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wohlauer M, Gonzalez E, Harr J, Droz N, Banerjee A, Silliman C, Moore E. Systemic Heparin Reduces Acute Lung Injury Following Trauma and Hemorrhagic Shock. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wohlauer M, Fragoso M, Harr J, Silliman C, Banerjee A, Moore E. Cross-transfusion of Postshock Mesenteric Lymph Provokes Acute Lung Injury. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Droz N, Wohlauer M, Gonzalez E, Harr J, Fragoso M, Silliman C, Moore E. Hemodilution is Not Critical in the Pathogenesis of the Acute Coagulopathy of Trauma. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhu JH, Chen CL, Flavahan S, Harr J, Su B, Flavahan NA. Cyclic stretch stimulates vascular smooth muscle cell alignment by redox-dependent activation of Notch3. Am J Physiol Heart Circ Physiol 2010; 300:H1770-80. [PMID: 21169401 DOI: 10.1152/ajpheart.00535.2010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mice deficient in Notch3 have defects in arterial vascular smooth muscle cell (VSMC) mechanosensitivity, including impaired myogenic responses and autoregulation, and inappropriate VMSC orientation. Experiments were performed to determine if Notch3 is activated by mechanical stimulation and contributes to mechanosensitive responses of VSMCs, including cell realignment. Cyclic, uniaxial stretch (10%, 1 Hz) of human VSMCs caused Notch3 activation, demonstrated by a stretch-induced increase in hairy and enhancer of split 1/hairy-related transcription factor-1 expression, translocation of Notch3 to the nucleus, and a decrease in the Notch3 extracellular domain. These effects were prevented by inhibiting the expression [small interfering (si)RNA] or proteolytic activation of Notch3 {N-(R)-[2-(hydroxyaminocarbonyl)methyl]-4-methylpentanoyl-l-naphthylalanyl-l-alanine-2-aminoethyl amide (TAPI-1; 50 μmol/l) to inhibit TNF-α-converting enzyme (TACE) or N-[N-(3,5-difluorophenacetyl-l-alanyl)]-S-phenylglycine t-butyl ester (DAPT; 20 μmol/l) to inhibit γ-secretase}. Stretch increased the activity of ROS within VSMCs, determined using dichlorodihydrofluorescein fluorescence. Catalase (1,200 U/ml), which degrades H₂O₂, inhibited the stretch-induced activation of Notch3, whereas in nonstretched cells, increasing H₂O₂ activity [H₂O₂ or manganese(III) tetrakis(1-methyl-4-pyridyl)porphyrin] caused activation of Notch3. Stretch increased the activity of TACE, which was prevented by catalase. Stretch-induced activation of p38 MAPK in VSMCs was inhibited either by catalase or by inhibiting Notch3 expression (siRNA). Stretch caused VSMCs to realign perpendicular to the direction of the mechanical stimulus, which was significantly inhibited by catalase or by inhibiting the expression (siRNA) or activation of Notch3 (TAPI-1 or DAPT). Therefore, cyclic uniaxial stretch activates Notch3 signaling through a ROS-mediated mechanism, and the presence of Notch3 is necessary for proper stretch-induced cell alignment in VSMCs. This mechanism may contribute to the physiological role of Notch3 in mediating developmental maturation of VSMCs.
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Affiliation(s)
- Jian-Hong Zhu
- Department of Anesthesiology and Critical Care, The Johns Hopkins University, Baltimore, Maryland, USA.
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Abstract
Pediatric nursing is deeply rooted in tradition and ritual. Although many practices remain relevant, others do not stand up to the challenge of an evidence-based nursing practice. Though intuition and tradition are important aspects of professional nursing practice, their incorporation into clinical practice can vary among practitioners. Although ample evidence to guide the practice of pain assessment and pain management in children exists, children remain undermedicated when compared to adults. This article explores the influence of practice traditions, personal bias, and the persistence of myths regarding pain in children on the practice of pain relief.
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Affiliation(s)
- S L Rush
- School of Nursing, University of California, San Francisco, USA
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Abstract
OBJECTIVE This study was undertaken to examine variation in therapies and outcome for pediatric head trauma patients by patient characteristics and by pediatric intensive care unit. Specifically, the study was designed to examine severity of illness on admission to the pediatric intensive care unit, the therapies used during the pediatric intensive care unit stay, and patient outcomes. DATA SOURCES AND SETTING Consecutive admissions from three pediatric intensive care units were recorded prospectively (n = 5,749). For this study, all patients with an admitting diagnosis of head trauma were included (n = 477). Data collection occurred during an 18-month period beginning in June 1996. All of the pediatric intensive care units were located in children's hospitals, had residency and fellowship training programs, and were headed by a pediatric intensivist. METHODS Admission severity was measured as the worst recorded physiological derangement during the period <or=6 hrs before pediatric intensive care unit admission. Therapies and resource use were based on the Therapeutic Intervention Scoring System with adaptations for pediatrics. The use of intracranial pressure monitoring was recorded on admission to the unit (within 1 hr) and at any time during the pediatric intensive care unit stay. Outcomes were measured at the time of pediatric intensive care unit discharge by the Pediatric Overall Performance Category scale. Risk factors for mortality were examined by using bivariate analyses with significant predictors as candidate variables in a logistic regression to predict expected mortality. Intracranial pressure monitoring and other therapies were added to the mortality prediction model to test for protective effects. Finally, race and insurance status were added to the model to test for differences in the quality of care. RESULTS The overall mortality rate for the entire sample was 7.8%. Mortality rates for children <or=1 yr old were significantly higher than for children >1 yr old (16.1% vs. 6.1%; p = .002). Comparisons by insurance status indicated that observed mortality rates were highest for self-paying patients. However, patient characteristics were not associated with use of therapies or standardized mortality rates after adjustment for patient severity. There was significant variation in the use of paralytic agents, seizure medications, induced hypothermia, and intracranial pressure monitoring on admission across the three pediatric intensive care units. In multivariate models, only the use of seizure medications was associated significantly with reduced mortality risk (odds ratio = 0.17; 95% confidence interval = 0.04-0.70; p = .014). CONCLUSIONS Therapies and outcomes vary across pediatric intensive care units that care for children with head injuries. Increased use of seizure medications may be warranted based on data from this observational study. Large randomized controlled trials of seizure prophylaxis in children with head injury have not been conducted and are needed to confirm the findings presented here.
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Affiliation(s)
- J M Tilford
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72202-3591, USA
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Harr J, Higgins S, Russell P. Characteristics of families enrolled in an isolated, mountain Head Start program: managing social capital. Issues Compr Pediatr Nurs 2001; 24:117-35. [PMID: 11817427 DOI: 10.1080/01460860120351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this exploratory, descriptive study was to identify the characteristics of families who chose to enroll their children in a Head Start program. Twenty families were asked questions about their level of education, financial assistance, driving distances to healthcare, and characteristics of their neighborhood. Families were asked about the educational aspirations they have for their children and the quality of their schools. How they felt about certain characteristics of their neighborhood, (respect for authority and unemployment) were not associated with families' willingness to be involved in Head Start activities or influence how they felt about their schools (p < .05). They were not involved in religious, political, or other community based organizations. For the parents who wanted their children to complete college, 80% had a high school education or less.
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Affiliation(s)
- J Harr
- University of San Francisco, California 94117-1080, USA.
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Higgins SS, Turley KM, Harr J, Turley K. Prescription and administration of around the clock analgesics in postoperative pediatric cardiovascular surgery patients. Prog Cardiovasc Nurs 1999; 14:19-24. [PMID: 10431315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Despite an increased awareness of postoperative pain management in infants and children, they are still often undermedicated. The importance of providing maximum comfort to children following cardiac surgery is accentuated with shortened hospital stays that require early ambulation to achieve early discharge. The purposes of this study were to evaluate the administration of prescribed around the clock (ATC) pain medication and documentation of pain assessment when administering pro re nata (prn) analgesics. A descriptive design was used to study 114 consecutive patients who underwent surgery for congenital heart disease. Administration of ordered ATC medications was best in the sternotomyl > 24 months of age group and poorest in the thoracotomyl < 24 months of age group. The use of the Wong-Baker FACES Pain Rating Scale in patients who were > 36 months of age (n = 71) was 38% for predose evaluation and only 15% for postdose evaluation. Findings suggest that the postoperative pain of infants and young children demands better attention. The administration of prescribed ATC medications is imperative in providing maximal postoperative pain relief in the pediatric cardiovascular surgery patient.
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Affiliation(s)
- S S Higgins
- University of San Francisco School of Nursing, CA 94117-1080, USA
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Abstract
The widespread use of the Internet and the development of the World Wide Web have led to a revolution in electronic communication and information access. The Association for Professional in Infection Control and Epidemiology (APIC) has developed a site on the World Wide Web to provide mechanisms for international on-line information access and exchange on issues related to the practice of infection control and the application of epidemiology. From the home page of the APIC Web site, users can access information on professional resources, publications, educational offering, governmental affairs, the APIC organization, and the infection control profession. Among the chief features of the site is a discussion forum for posing questions and sharing information about infection control and epidemiology. The site also contains a searchable database of practice-related abstracts and descriptions and order forms for APIC publications. Users will find continuing education course descriptions and registration forms, legislative and regulatory action alerts and a congressional mailer, chapter and committee information, and infection control information of interest to the general public. APIC is considering several potential future enhancements to their Web site and will continue to review the site's content and features to provide current and useful information to infection control professionals.
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Affiliation(s)
- J Harr
- Association for Professionals in Infection Control and Epidemiology, Inc., Washington, DC 20036, USA
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Metzler DJ, Harr J. Positioning your patient properly. Am J Nurs 1996; 96:33-7. [PMID: 8607544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- D J Metzler
- Bellin College of Nursing, Green Bay, WI, USA
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Gortner SR, Jaeger AA, Harr J, Miller T. Elders' expected and realized benefits from cardiac surgery. Cardiovasc Nurs 1994; 30:9-14. [PMID: 8137373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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