Evaluation of bruises and areas of induration after two techniques of subcutaneous heparin injection

The subcutaneous administration of the anticoagulant heparin sodium is a frequently performed nursing intervention. Bruising (discoloration) and induration (hardening) occur after some but not all such injections. This has implications for nursing; not only does the patient experience the physical discomfort and the psychologic impact of visible body trauma, but bruising and induration limit possible sites for future injections. Administration technique is frequently cited as a possible cause of bruising and induration. The purpose of this study was to compare two administration techniques currently being used by nurses. Variables studied included syringe size, change of needles after drawing medication into the syringe, use of an air bubble, and type of sponge (dry or alcohol) applied to the site after injection. The sample included 50 medical-surgical patients aged 23 to 88 years. Each subject received two injections by the same investigator using two different techniques. Sites were inspected and bruises and induration measured 52 hours after each injection. To compare the size of bruises and indurations, the data were analyzed by the Mann-Whitney U-Wilcoxon rank sum test, which showed a 0.003 level of significance for bruises and a 0.02 level of significance for induration. To compare the number of subjects in whom bruises and indurations developed, the data were analyzed by the chi-square test, which showed a 0.0458 level of significance for induration but only a 0.1371 level of significance for bruising.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lipid and insulin concentrations in obese postmenopausal women: separate effects of energy restriction and weight loss.

The separate effects of energy restriction and weight loss on serum lipids were studied in 24 postmenopausal moderately obese women before and after weight loss of greater than 10 kg to normal weight. Fasting serum triglycerides (TGs), total cholesterol (TC), high-density-lipoprotein (HDL) and low-density-lipoprotein (LDL) cholesterol, and insulin were measured at the end of four 10-d in-hospital phases, two before and two after weight loss: phase I, stable weight; phase II, 3350 kJ/d(800 kcal/d), followed by outpatient weight loss; phase III, 3350 kJ/d (800 kcal/d); and phase IV, stable weight. Diet composition and exercise were constant the entire study. Energy-restriction effect was determined by comparing average values in stable-weight phases (I and IV) with low-energy phases (II and III); weight-loss effect was determined by comparing values in obese phases (I and II) with reduced-weight phases (III and IV). Energy restriction lowered TG, TC, LDL cholesterol, the LDL-HDL cholesterol ratio, and insulin and raised HDL cholesterol (all P less than 0.05). Weight loss lowered TG, TC, LDL cholesterol, and insulin (all P less than 0.01) but did not change HDL cholesterol or the LDL-HDL cholesterol ratio. The results suggest that reduction to a weight-steady nonobese state significantly lowers TG, TC, and LDL cholesterol but does not improve HDL cholesterol or the LDL-HDL cholesterol ratio.     

Immunostimulatory oligodeoxynucleotides induce apoptosis of B cell chronic lymphocytic leukemia cells

Immunostimulatory oligodeoxynucleotides (IS ODN) can mediate a number of immunologic effects. We previously demonstrated that treatment of B cell chronic lymphocytic leukemia (B-CLL) cells with one class of IS ODN, CpG ODN, alters their phenotype and increases their immunogenicity. Here, we demonstrate that in contrast to the classic understanding of CpG ODN as inhibitors of B cell apoptosis, IS ODN including CpG ODN induce apoptosis in B-CLL cells. It is important that these changes are seen not only with CpG ODN but with ODN that lack the classical CpG motif. B-CLL cells from 20 subjects were treated in vitro with IS ODN for up to 7 days. IS ODN treatment resulted in increased numbers of apoptotic cells in 13 out of 20 B-CLL samples. IS ODN enhanced apoptosis in samples with 13q deletion as a single aberration and had a heterogeneous effect on apoptosis in samples with other aberrations including 17p deletion, 11q deletion, or trisomy 12. Induction of apoptosis did not correlate with expression of the CpG ODN receptor Toll-like receptor 9. Apoptosis was dependent on the activation of caspases and was accompanied by up-regulation of CD95/Fas and its ligand. We conclude that IS ODN including CpG ODN can induce apoptosis of most B-CLL samples. The ability of IS ODN to induce apoptosis differs based on cytogenetic status. Up-regulation of CD95/Fas may play a role in IS ODN-induced apoptosis of B-CLL.     

Transdermal microconduits by microscission for drug delivery and sample acquisition

Background  

Painless, rapid, controlled, minimally invasive molecular transport across human skin for drug delivery and analyte acquisition is of widespread interest. Creation of microconduits through the stratum corneum and epidermis is achieved by stochastic scissioning events localized to typically 250 μm diameter areas of human skin in vivo.     

MILITANCY TRAUMA : MAXILLOFACIAL INJURY,ANAESTHESIA AND CRITICAL CARE

Eighty four out of 2151 militancy trauma patients sustained severe maxillofacial injury from Jan 1990 to March 1993. The resuscitation, stabilisation and intensive care of these patients was based on management priorities of primary resuscitation, care of airway, management of haemodynamics, oxygenation and monitoring. Anaesthesia was administered in a situation when the airway was likely to be compromised and the patients were critically sick. Initial ventilation and oxygenation was the most difficult and could be achieved with satisfactory seal around the face mask by applying water-soaked guaze pieces around the mouth and nose to “fill-in” the defects. Tracheal intubation could be accomplished with intravenous sedation by an experienced anaesthesiologist. Dental occlusion and wiring necessiated the placement of nasotracheal tube for 48-72 hours after surgery.KEY WORDS: Trauma, Maxillofacial injury, Trauma anesthesia, Anaesthesia and critical care     

A "convertible pore" model of neural membrane conductance.

Instead of the single-channel pore proposed earlier [Wooldridge, D. E. (1984) Proc. Natl. Acad. Sci. USA 81, 5609-5612] for the transit of conductance ions through the neural membrane, a pore with a second channel for "influence ions" of calcium or magnesium is considered in this paper. By entering trapping centers at the closed inner ends of the new channels, the influence ions are postulated to alter the rates of chemical reactions that change the configurational state of the gates guarding the inner ends of the nearby conductance channels. This makes the permeability of the conductance channels strongly dependent on voltage. Using a four-state reaction scheme for both the sodium and potassium pore systems, a computer model of the membrane conductance is constructed. When suitable values are assigned to its parameters, the model closely reproduces the results of the Hodgkin-Huxley voltage-clamp and action potential experiments.     

Actuarial survival in the premature infant less than 30 weeks' gestation

OBJECTIVE: Because survival from admission to discharge does not provide parents and physicians information about future life expectancy in the premature neonate, we characterized the actuarial survival, defined as the future life expectancy from a given postnatal age, in a large inborn population of premature infants < 30 weeks' gestation. STUDY DESIGN: We determined daily actuarial survival of 1925 inborn infants (23 to 29 weeks' gestation) admitted to the Baylor Affiliated Nurseries from July 1986 through December 1994, stratified by 100-g birth weight and by 1-week gestational-age intervals. RESULTS: In the 501- to 600-g birth weight stratum, actuarial survival improved from 31% at birth, to 61% on day of life 7, and then to 75% on day of life 28; in the 901- to 1000-g birth weight stratum, actuarial survival improved from 88%, to 94%, and then to 98% throughout the same times, respectively. Similar trends were obtained when data were stratified by gestational age. CONCLUSIONS: Survival in the smallest infants improves dramatically during the first few days of life, but there is a significant risk for late death in the smallest of these infants.