The socioeconomic burden of hospital acquired infection

Adult inpatients in common specialties who developed hospital acquired infection (HAI) remained in hospital 2.5 times longer, incurred hospital costs almost three times higher, and incurred higher general practitioner, district nurse, and hospital costs a     

Intra-abdominal pressure and rowing: the effects of inspiring versus expiring during the drive

BACKGROUND: The lumbar vertebrae of rowers are subjected to high levels of shear and compression at mid-drive, but intra-abdominal pressure (IAP) may partially neutralize these forces. IAP fluctuates with breathing. This study compared the IAP between inspiring during the drive and expiring during the drive. METHODS: Experimental design: ten volunteers performed one 5x2-minute repetition test while inspiring during the drive and one 5x2-minute repetition test while expiring during the drive on a rowing ergometer. The five work rates were: 100, 125, 150, 175 and 200 watts at 22, 24, 26, 28 and 30 strokes per minute, respectively. Measures: the movement of the body while rowing was analyzed using a position sensor, and IAP was measured using a pressure transducer catheter. RESULTS: A 2x5 repeated measures analysis of variance showed that there was a significant interaction for the dependent variable mid-drive IAP (p<0.05), with the mid-drive IAP increasing at a greater rate while expiring during the drive relative to inspiring during the drive. Across work rate, the mid-drive IAP and minimal IAP were significantly higher while expiring during the drive than inspiring during the drive (p<0.05). Across breathing pattern, the minimal IAP, maximal IAP, average change in IAP and mid-drive IAP increased significantly with work rate (p<0.05). CONCLUSIONS: The data show that expiring during the drive leads to a greater mid-drive IAP than inspiring during the drive.     

Gap junction expression following UVC-induced neoplastic transformation in human hybrid cell lines

Decreased connexin gene expression and loss of the capacity for either homologous or heterologous intercellular communication has been associated with neoplastic transformation. We tested the hypothesis that loss of gap junctional intercellular communication (GJIC) correlates with tumorigenic potential in the HeLa x skin fibroblast human hybrid cell system. Connexin gene expression, gap junction function and tumorigenicity were determined for the non-tumorigenic somatic hybrid cell line (CGL1) and a series of UVC-induced tumorigenic cell lines derived from CGL1. CGL1 and the parental skin fibroblasts express connexin43 (alpha1 gap junction gene) mRNA and protein, form gap junctional plaques and have functional gap junctions. UVC- irradiation of CGL1 cells produced a cell line (UV12) with an aggressive tumorigenic phenotype, which lost connexin43 expression as well as both homologous and heterologous GJIC and was in this respect similar to HeLa cells. However, the phenotype of UV12 cells exhibited some instability and revertants to a less aggressive tumorigenic phenotype were isolated. These cells expressed connexin43 mRNA and protein, and demonstrated homologous GJIC. Furthermore, cells reconstituted from a tumor derived from this revertant cell line retained significant connexin43 expression and homologous GJIC, although they exhibited an aggressive tumorigenic phenotype. Thus, functional homologous GJIC cannot be dissociated from tumorigenicity in this system. However, heterologous GJIC between these same UVC-induced tumorigenic cell lines and normal human skin fibroblasts was reduced, whereas the non-tumorigenic hybrid cells showed extensive heterologous GJIC. In summary, re-acquisition of connexin43 expression and homologous GJIC does not restore the non-tumorigenic phenotype in UVC- induced tumorigenic HeLa skin fibroblast human hybrid cells. However, reduction of heterologous GJIC does correlate with tumorigenicity in this cell system.      

Effect of flow rate and insulin priming on the recovery of insulin from microbore infusion tubing

BACKGROUND: A retrospective medical record review of 13 consecutive, hyperglycemic, extremely low birth weight (ELBW) infants treated with continuous insulin infusions revealed a 14- to 24-hour delay (mean, 19 hours) in blood glucose normalization despite stepwise increases in insulin infusion rates. OBJECTIVE: This in vitro study examined the effects of flow rate and insulin priming on insulin recovery from polyvinyl chloride (PVC) tubing and polyethylene (PE)-lined PVC tubing infused with a standard insulin stock solution. METHODS: Stock insulin solution (0.2 U/mL) was infused through microbore PVC or PE-lined tubing at flow rates of 0.05 and 0.2 mL/h. To determine if saturation of nonspecific binding sites would alter effluent insulin concentration, we compared insulin recovery from tubing previously flushed with the stock solution and tubing primed with 5 U/mL of insulin for 20 minutes. Effluent samples, which were collected at baseline and at six time points during a 24-hour period, were immediately frozen at -20 degreesC. Insulin concentration was measured by IMx immunoassay. Data were analyzed using general linear modeling with repeated measures. RESULTS: At 0.05 mL/h flow rate, insulin recovery from unprimed PVC tubing at 1, 2, 4, and 8 hours was 17%, 11%, 27%, and 55%, respectively, with 100% recovery at 24 hours. From insulin-primed tubing, insulin recovery was approximately 70% at 1, 2, and 4 hours, and close to 100% at 8 hours. At a faster flow rate of 0.2 mL/h, insulin recovery at 1, 2, 4, and 8 hours was 22%, 38%, 67%, and 75% vs 42%, 85%, 91% and 95% from unprimed and insulin-primed PVC tubing, respectively. Similar results were obtained from unprimed and insulin-primed PE-lined tubing at 0.2 mL/h flow rate. CONCLUSIONS: Priming of microbore tubing with 5 U/mL of insulin solution for 20 minutes to block nonspecific binding sites enhances delivery of a standard insulin stock at infusion rates typically used to treat hyperglycemic ELBW infants. We conclude that priming the tubing with a higher concentration of insulin before initiation of standard insulin infusion therapy should accelerate achievement of steady-state insulin delivery and correction of hyperglycemia in ELBW infants.     

An assessment of sources of information in post-perinatal infant death reviews

The objective of this study was to identify adverse social and medical factors contributory to post-perinatal deaths and at which stage of the case study each factor was found. The sources of information assessed were: (i) recorded data from case notes, laboratory and postmortem findings, and (ii) created information from (a) home interview and (b) case discussion held in the family doctor's office. The deaths were categorized into seven clinicopathological groups and adverse factors into general demographic and personal psychosocial. Among the 87 sequential post-perinatal infant deaths, 325 adverse factors were identified; of these, 125 (38%) were judged to be actionable by the carers. Of 183 (56%) adverse factors found in the case notes, only 36 were actionable. Forty-five more adverse factors were found at home interview; 26 (58%) of these were actionable. At case discussion another 97 adverse factors were revealed; 63 (65%) were actionable, thus proving the most important source of actionable information.     

Synovial sarcoma: An unexpected ultrasound finding in a post-partum patient

A 20-year-old patient presented after an uneventful pregnancy and delivery with an asymptomatic soft-tissue mass behind her knee with the clinical features of a ganglion or Baker's cyst. An ultrasound scan demonstrated a well-defined but solid mass with prominent vascularity. The mass was noted to increase in size prior to surgery. The pathological diagnosis was that of a synovial sarcoma grade 2, a rare malignant mesenchymal neoplasm with a serious prognosis.     

Cranial irradiation for cerebral and nasopharyngeal tumours in children: evidence for the production of a hypothalamic defect in growth hormone release

A synthetic 29-amino acid analogue of human pancreatic GH-releasing hormone (GHRH(1-29)NH2) has recently been shown to stimulate the release of GH in normal subjects. We have studied the GH response to GHRH(1-29)NH2 in nine children irradiated for brain and nasopharyngeal tumours, who were not growing and were deficient in GH as assessed by insulin-induced hypoglycaemia. Serum GH rose in response to GHRH(1-29)NH2 in all the children, and in five the peak serum GH response was greater than 20 mu./l. The data suggest that when hypothalamo-pituitary irradiation results in GH deficiency, this is due to a failure of the synthesis or delivery of endogenous GHRH from the hypothalamus to the pituitary cells. It also suggests that it may be possible to treat such children using synthetic GHRH in place of exogenous GH.