Reducing intraocular pressure by intubation elicits precocious development and innervation of the embryonic chick cornea.
(25/190)
Growth of the embryonic chick cornea was directly related to, and coordinated with, overall eye growth. During normal development, the size of the embryonic chick cornea increased in three linear phases of diametric growth. Corneal diameter increased at a rate of 216 microns per day between embryonic day 4 (E4) and E7, 511 microns per day between E7 and E10, and 144 microns per day from E10 until after hatching. After the sustained release of intraocular pressure by intubation on E4, corneal diametric growth was reduced to a single phase of 122 microns per day. After intubation on E4, the mesenchyme surrounding the developing cornea was substantially thicker and the neural crest-derived corneal endothelium was established earlier. The primary corneal stroma of the intubated eye swelled and was precociously populated by neural crest-derived corneal fibroblasts. Thus, the timing of arrival of neural crest cells in the anterior segment and their contribution to the cornea were determined by the growth rate of the eye. Although the diameter of the cornea was substantially reduced after intubation, it was more densely populated by fibroblasts, resulting in a cornea that was substantially thicker than the control by E14. Prospective corneal nerves normally extend into the cornea proper on E11, concomitant with a decrease in its diametric growth rate. After intubation on E4, the perilimbal nerve ring was virtually complete by E5 and numerous nerves had extended throughout the E8 cornea. By E16, the cornea from the intubated eye contained a very high density of nerve fibers, possibly reflecting its reduced size. These data suggest that the primary corneal stroma does not permit nerve fiber extension and demonstrate that the timing of nerve fiber extension into the secondary corneal stroma is specified by the rate of oppositional diametric growth of the cornea. (+info)
Neonatal transfers by advanced neonatal nurse practitioners and paediatric registrars.
(26/190)
OBJECTIVE: To evaluate the safety and practicality of using advanced neonatal nurse practitioners (ANNPs) to lead acute neonatal transfers. DESIGN: Comparison of transport times, transport interventions, and physiological variables, covering the first four complete years of operating a transport service that uses ANNPs and specialist paediatric registrars (SpRs) interchangeably. SETTING: Tertiary neonatal transport service. PATIENTS: The first 51 transfers of sick infants under 28 days of age by an ANNP led transport team into Nottingham compared with the next consecutive SpR led transfer after each ANNP led one. MAIN OUTCOME MEASURES: Transport times; interventions and support given during stabilisation for transfer and during transfer; condition on completion of transfer, assessed from blood glucose, systolic blood pressure, pH, oxygenation, and temperature. RESULTS: The ANNP led team responded more rapidly to requests for transfer and took longer to stabilise babies. The groups undertook similar numbers of procedures during stabilisation, and there were no differences in the ventilatory and other support that infants needed in transit. The infants transferred by the doctor led group had worse values for pH (doctor led, 7.31 (6.50-7.46); ANNP led, 7.35 (7.04-7.50), p = 0.02) and PaO(2) (doctor led, 6.7 (2.4-13.1); ANNP led, 8.7 (3.5-17.0); p = 0.008) before transfer (all values median (range)). Comparisons of the infant's condition before and after transfer showed a significant improvement in temperature for the infants transferred by ANNP led teams (36.8 degrees C (34.0-37.8) v 37.0 degrees C (34.6-38.0), p = 0.001) and in oxygen saturation (96% (88-100) v 98% (92-100), p = 0.01). There were no differences between the ANNP and doctor led groups in the values obtained for any variable after transfer. CONCLUSIONS: Clinical condition on completion of transport is similar for babies transferred by ANNP and doctor led teams. ANNP led transport appears to be practical and safe. (+info)
Combined electro-acupuncture with liver artery intubation in treatment of massive liver cancer.
(27/190)
OBJECTIVE: To investigate the clinical effectiveness of electro-acupuncture therapy (EAT) in combination with liver artery intubation chemotherapy for massive liver cancer. METHODS: A total of 106 patients were divided into 3 groups. In group A, patients underwent EAT in combination with invasive therapy. In group B, patients received EAT alone. In group C, patients underwent liver artery intubation chemotherapy. In group A and B, subcostal oblique incision was performed to expose liver cancer, and electrodes were inserted into the tumor under direct vision. In group A, liver artery intubation was performed during operation, followed by chemotherapy through the tube. Liver artery intubation chemotherapy was performed only in group C. RESULTS: The effective rate was 73.7% (28/38), 55.6% (20/36) and 28.1% (9/32) in group A, B and C, respectively. CONCLUSIONS: Electro-acupuncture therapy in combination with liver artery intubation chemotherapy achieves best results. It is an effective therapy for massive liver cancer. (+info)
Advanced airway management in the emergency department: what are the training and skills maintenance needs for UK emergency physicians?
(28/190)
This article reviews the evidence for the training of emergency physicians in advanced airway management. (+info)
Cell-to-cell signaling involving N-acyl-homoserine lactone compounds termed autoinducers (AIs) is instrumental to virulence factor production and biofilm development by Pseudomonas aeruginosa. In order to determine the importance of cell-to-cell signaling during the colonization of mechanically ventilated patients, we collected 442 P. aeruginosa pulmonary isolates from 13 patients. Phenotypic characterization showed that 81% of these isolates produced the AI-dependent virulence factors elastase, protease, and rhamnolipids. We identified nine genotypically distinct P. aeruginosa strains. Six of these strains produced AIs [N-butanoyl-homoserine lactone or N-(3-oxo-dodecanoyl)-homoserine lactone] and extracellular virulence factors (elastase, total exoprotease, rhamnolipid, hydrogen cyanide, or pyocyanin) in vitro. Three of the nine strains were defective in the production of both AIs and extracellular virulence factors. Two of these strains had mutational defects in both the lasR and rhlR genes, which encode the N-acyl-homoserine lactone-dependent transcriptional regulators LasR and RhlR, respectively. The third of these AI-deficient strains was only mutated in the lasR gene. Our observations suggest that most, but not all, strains colonizing intubated patients are able to produce virulence factors and that mutations affecting the cell-to-cell signaling circuit are preferentially located in the transcriptional regulator genes. (+info)
The MiniCAP III CO2 Detector: assessment of a device to distinguish oesophageal from tracheal intubation.
(30/190)
A new portable infra-red CO2 detector was assessed in 50 intubated patients. This device was 100% accurate in distinguishing between tracheal and oesophageal intubation when used by nursing and paramedic personnel. (+info)
Ultrasonically induced in vitro cell lysis: node-antinode interactions.
(31/190)
An attempt was made to discriminate between two hypotheses (standing wave, bubble recycling) of the mechanism of ultrasonically induced cell lysis in a rotating tube. A tube containing an aqueous suspension of P-388 cells was moved back and forth (+/- 3 or +/- 7 mm) during insonation (1 MHz, 5 W/cm2, continuous wave, 5 min). Cell lysis (approximately 20%) occurred. As a positive control, some tubes were also partially or completely rotated during insonation; considerable cell lysis (approximately 60%) occurred. The results are interpreted to suggest that both hypotheses are simultaneously useful in explaining the observed effect of cell lysis in a rotating tube. (+info)
Perioperative use of the modified nasal trumpet in 346 patients.
(32/190)
BACKGROUND: The modified nasal trumpet (MNT) is a prepackaged nasopharyngeal airway modified with distal holes and fitted with a 15 mm adaptor allowing connection to an anaesthesia circuit. It may be useful for airway management during anaesthesia. METHODS: After applying a spray to constrict the nasal mucosa, we used the MNT in 346 spontaneously breathing patients for three indications: alone as an airway device during general anaesthesia, to provide supplemental oxygen immediately after extubation instead of by facemask, and to facilitate fibreoptic intubation during general anaesthesia. RESULTS: The device was successful for giving supplemental oxygen after extubation (n=244) and facilitating fibreoptic intubation (n=28). When used as an airway for general anaesthesia, it was only successful without manipulation in 33 of 74 patients (45%). The MNT was easy to insert in awake patients. We encountered six complications: one MNT folded in the pharynx, and five patients (1.4%) experienced nosebleeds. CONCLUSIONS: The MNT was disappointing as a primary airway device under general anaesthesia but was useful for giving oxygen after extubation and for facilitation of fibreoptic intubation. It can cause nosebleeds. (+info)