THE EXCRETION OF FREE NORADRENALINE AND ADRENALINE BY HEALTHY YOUNG SUBJECTS AND BY PATIENTS WITH ESSENTIAL HYPERTENSION

The possible relationship between arterial pressure and the excretion of free noradrenaline and adrenaline in the urine was the subject of a study of 58 university students and 33 patients with untreated essential hypertension. The urine was collected during the morning with the subjects fasting, recumbent and undisturbed. The mean excretion rate of free noradrenaline by the students was 0.94 µg. per hour and by the hypertensives, 1.65 µg. per hour. The mean excretion rates of free adrenaline were 0.47 and 0.73 µg. per hour respectively. Although the difference in catecholamine excretion rates between the two groups was highly significant (P = < 0.01), there was a considerable overlap. There was a significant correlation with the student group between the excretion of both free noradrenaline and adrenaline and the systolic blood pressure, demonstrating that, in normal subjects, casual blood pressure at rest is partly although not very closely related to catecholamine production. Although catecholamine excretion rates were higher in the hypertensive group, a significant correlation with blood pressure was not found.     

Bluetongue Virus and Double-Stranded RNA Increase Human Vascular Permeability: Role of p38 MAPK

Endothelial cell (EC) involvement in viral hemorrhagic fevers has been clearly established. However, virally activated mechanisms leading to endothelial activation and dysfunction are not well understood. Several different potential mechanisms such as direct viral infection, alterations in procoagulant/anticoagulant balance, and increased cytokine production have been suggested. We utilized a model of EC barrier dysfunction and vascular endothelial leakage to explore the effect of bluetongue virus (BTV), a hemorrhagic fever virus of ruminants, on human lung endothelial cell barrier properties. Infection of human lung EC with BTV induced a significant and dose-dependent decrease in trans-endothelial electrical resistance (TER). Furthermore, decreases in TER occurred in conjunction with cytoskeletal rearrangement, suggesting a direct mechanism for viral infection-mediated endothelial barrier disruption. Interestingly, double-stranded RNA (dsRNA) mimicked the effects of BTV on endothelial barrier properties. Both BTV- and dsRNA-induced endothelial barrier dysfunction was blocked by treatment with a pharmacological inhibitor of p38 MAPK. The induction of vascular permeability by dsRNA treatment or BTV infection was concomitent with induction of inflammatory cytokines. Taken together, our data suggest that the presence of dsRNA during viral infections and subsequent activation of p38 MAPK is a potential molecular pathway for viral induction of hemorrhagic fevers. Collectively, our data suggest that inhibition of p38 MAPK may be a possible therapeutic approach to alter viral-induced acute hemorrhagic diseases.     

Survivorship in cancer care

DOYLE N. (2010) European Journal of Cancer Care 19 , 284
Survivorship in cancer care An increasing number of people are living with and beyond a cancer diagnosis. Health professionals need to understand the complexity of cancer survivorship and develop skills to help support people living with cancer.     

Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review

Aim  The aim of this study was to review the effects of early developmental intervention after discharge from hospital on motor and cognitive development in preterm infants.
Method  Randomized controlled trials (RCTs) or quasi-RCTs of early developmental intervention programmes for preterm infants in which motor or cognitive outcomes were reported and in which the intervention commenced before or after discharge were included. A systematic review and meta-analysis of studies grouped by intervention, age of outcome, and study quality was undertaken. Databases searched (up to January 2009) included the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, PsycINFO, and Embase.
Results  Eighteen studies met the inclusion criteria (2686 patients randomized), but only 11 studies had data suitable for meta-analysis. Early developmental intervention improved cognitive outcomes at infant age (developmental quotient: standardized mean difference [SMD] 0.42, 95% confidence interval [CI] 0.33–0.52; p <0.001), and at preschool age (IQ: SMD 0.46, 95% CI 0.33–0.59; p <0.001). However, the benefit was not sustained at school age (IQ: SMD 0.02, 95% CI –0.10 to 0.14; p =0.71). Early intervention had little effect on motor outcome at infant or school age, and there was no study reporting motor outcome at preschool age.
Interpretation  Current evidence suggests that the benefits of developmental intervention postdischarge are restricted to short-term gains in cognitive outcome.     

Bronchopulmonary dysplasia and very low birthweight: Lung function at 11 years of age

Objective : To determine the relationship between lung function at 11 years of age and bronchopulmonary dysplasia (BPD) in very low birthweight (VLBW) children.
Methodology : This study comprised 154 consecutive surviving VLBW children, divided into three groups with respect to their neonatal respiratory morbidity: group I developed BPD; group II required assisted ventilation but did not develop BPD; and group III required no assisted ventilation. Lung function tests were measured on 120/154 (77.9%) children at 11 years of age. The relationship between various lung function variables and neonatal lung disease was analysed by multiple linear regression.
Results : Several lung function variables reflecting airflow were significantly diminished in the BPD group ( n = 15), and residual volume was significantly higher. Despite poorer lung function overall, few children in the BPD group had lung function abnormalities in the clinically significant range ( n = 2 [13.3%] with a forced expired volume in 1 s <75% predicted; n = 2 [13.3%] with a forced vital capacity <75% predicted; n = 1 [6.7%] with a residual volume/total lung capacity >35%). There were no significant differences in lung function variables between group II ( n = 41) and group III ( n = 64). Changes in lung function tests between 8 and 11 years did not vary significantly between the three groups.
Conclusions : VLBW children with BPD in the newborn period have poorer lung function at 11 years of age than other surviving VLBW children without BPD, although few have lung function abnormalities in the clinically significant range.     

Selective improvement in cognitive test scores of extremely low birthweight infants aged between 2 and 5 years

Abstract The cognitive development at 2 and 5 years of a cohort of extremely low birthweight (ELBW) children (birthweight 500-999 g) was compared with that of cohorts of larger very low birthweight (VLBW) children (birthweight 1000-1500 g) and normal birthweight (NBW) children (birthweight > 2500 g) to determine whether the improvements in cognitive function of ELBW infants between 2 and 5 years are apparent or real.
At 2 years of age, ELBW children had a mean Mental Developmental Index (MDI) on the Bayley Scales of 90.4, significantly lower than the means of 100.3 for the larger VLBW children ( P = 0.006), and 107.8 for the NBW children ( P = 0.0002). However by 5 years the mean scores on the Wechsler Preschool and Primary Scales of Intelligence (WPPSI) full-scale for the ELBW and larger VLBW children were virtually identical (105.9 and 106.0 respectively)—but still lower than the mean WPPSI full-scale of 114.6 for the NBW children. After standardizing the MDI and WPPSI scores relative to the NBW children, the ELBW children improved between 2 and 5 years (paired t -test, t = 3.2, P = 0.004) whereas the larger VLBW infants did not.
We postulate that ELBW children require more time than larger VLBW children after birth to compensate for perinatal and other stresses, and that developmental delay at 2 years may not always persist to 5 years.     

AN ASSESSMENT OF THE COMPREHENSION OF THE AMERICAN UROLOGICAL ASSOCIATION SYMPTOM INDEX

Purpose

We determine the reading grade level of the American Urological Association (AUA) symptom index, and assessed patient ability to read and understand the index using a standardized reading and IQ test.

Materials and Methods

The reading grade level required to read and understand the AUA symptom index was determined using the Spache and Dale-Chall readability formulas. A total of 202 men a mean of 66.1 years old completed the AUA symptom index, Wonderlic personnel test and scholastic level examination, and revised Ohio literacy test. Patients were instructed to report any difficulty in reading or understanding the AUA symptom score.

Results

According to the Spache and Dale-Chall readability formulas, the AUA symptom index requires a grade 6 reading level. Of the 202 patients 30 (14.9%) did not complete the symptom index due to an inability to read it (28, 13.9%) and poor comprehension (2, 1%). Tested mean IQ and reading grade level was 91.7 and 11, respectively.

Conclusions

A grade 6 reading level is required to read and understand the AUA symptom index. A significant percentage of patients cannot read the index and require assistance from others for its completion. This assistance may introduce significant interviewer bias, potentially altering study outcome.     

PATIENT-CONTROLLED ANALGESIA WITH LOW DOSE BACKGROUND INFUSIONS AFTER LOWER ABDOMINAL SURGERY IN CHILDREN

Forty-five children (aged 6–12 yr) undergoing appendicectomyreceived one of three analgesic regimens using patient-controlledanalgesia (PCA) with morphine: no background infusion (BO);background infusion 4 µg kg^–1 h^–1 (B4); backgroundinfusion 10 µh^–1 h^–1 (B10). Total consumptionof morphine was greater in group B10 compared with groups BO(P<0.01) and B4 (P<0.05). There was no significant differencein morphine consumption in groups BO and B4. All three groupsself-administered similar amounts of morphine and there wereno significant differences in pain scores or incidence of excessivesedation. Group B4 suffered less hypoxaemia compared with groupsBO (P<0.01) and B10 (P<0.001). Group B10 suffered morenausea and vomiting than groups BO (P<0.001) and B4 (P<0.001),but there was no significant difference in the incidence ofnausea and vomiting between groups BO and B4. Groups B4 andB10 spent more time at night asleep than group BO (P<0.05).There were no significant differences between the groups inthe amount of time spent asleep during the day. Inclusion ofa background infusion of morphine 4 µg kg^–1 h^–1in a PCA regimen for children did not increase the incidenceof side effects and was associated with less hypoxaemia anda better sleep pattern than no background infusion. (Br. J.Anaesth. 1993; 71: 818–822)     

THE CONTUSION INDEX: A REAPPRAISAL IN HUMAN AND EXPERIMENTAL NON-MISSILE HEAD INJURY

A previously described method of quantifying cerebral contusions in man (the contusion index) caused by non-missile head injury has been modified and applied to a larger series of cases, and used to assess contusions in experimental head injuries. The initial findings in man have been confirmed, viz. that contusions are most severe in the frontal and temporal lobes; that contusions may be entirely absent in a patient dying as a result of a head injury; that there is no correlation between the severity of contusions and the nature of the injury; that the concept of contrecoup must continue to be questioned; that contusions are more severe in patients who have a fracture of the skull in comparison to those who do not; that contusions are more severe in patients who do not experience a lucid interval than in those who do; and that contusions are less severe in patients with diffuse axonal injury than in those who do not have diffuse axonal injury. The distribution of contusions in subhuman primates is similar to that seen in man, and they occur more frequently with short duration than with long duration acceleration.