A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure.

UNLABELLED: The objectives of this study were (1) to devise a nasal trauma score for preterm infants receiving non-invasive respiratory support, (2) to compare the incidence of nasal trauma in preterm infants <32 weeks gestation randomised to either nasal continuous positive airway pressure (NCPAP) or heated humidified high-Flow nasal cannulae (HHHFNC), in the first 7 days post-extubation and (3) to assess the effect of two different nasal dressings in those assigned to NCPAP. We randomly assigned preterm ventilated infants to receive Vapotherm® HHHFNC or NCPAP post-extubation. Infants receiving HHHFNC were treated with Sticky Whiskers® and infants receiving NCPAP received either Sticky Whiskers® or Cannualaide® nasal dressings. Bedside nursing staff scored six sites on each infant's nose for erythema, bleeding or ulceration. Scores were recorded three times daily for the first 7 days post-extubation. The sum of these 21 scores was used as the summary measure of nasal trauma. The mean nasal trauma score for infants assigned HHHFNC was 2.8 (SD 5.7) compared to 11.7 for NCPAP (SD 10.4), p < 0.001. There was no difference in mean trauma score between infants on NCPAP assigned Sticky Whiskers® 14.4 (SD 12.5) or Cannualaide® 9.5 (SD 7.3), p = 0.06. CONCLUSION: HHHFNC resulted in significantly less nasal trauma in the first 7 days post-extubation than NCPAP and was most significant in infants <28 weeks of gestation. The use of protective dressings was not associated with decreased nasal trauma for infants on NCPAP.

Violence in youth sports: hazing, brawling and foul play.

By separating hazing, brawling, and foul play and failing to recognise that their connection to sport binds them together into a cohesive subset of sport injury and youth violence, past research has failed to show how sports-related violence is a broad example of interpersonal violence. The acceptance of violence within the sporting culture may, in part, explain why sports-related violence has not yet been widely recognised as a public health concern. This review shows that sports-related violence, including hazing, brawling and foul play, occurs among youth athletes of all ages and in a variety of different sports. The few studies to address this issue have all acknowledged the dangers of sports-related violence; however, no incident tracking method has been developed. Future research must provide accurate national estimates of the incidence of sports-related violence among youth, identify associated risk factors, evaluate preventive interventions and identify effective methods of distributing and implementing evidence-based interventions. Monitoring the magnitude and distribution of the burden of sports-related violence and building the scientific infrastructure necessary to support the development and widespread application of effective sports-related prevention interventions are essential first steps toward a reduction in the incidence of sports-related violence.

Poorer lifetime growth performance of gilt progeny compared with sow progeny is largely due to weight differences at birth and reduced growth in the preweaning period, and is not improved by progeny segregation after weaning.

Gilt progeny (GP) are born and weaned lighter than sow progeny (SP) and have higher rates of mortality. This study aimed to quantify the performance and survival differences between GP and SP throughout the entire production cycle from birth to sale. Furthermore, the study looked at the effects of segregating GP and SP compared with commingling during rearing within common pens. It was hypothesized that GP would be lighter than SP at every age and have lower rates of survival accompanied by higher rates of medication, and that segregating GP and SP would improve the growth and survival of both groups. All progeny born to 109 gilts (parity 1) and 94 sows (parities 2 to 8) were allocated to 4 postweaning treatments at birth: GP separately penned, GP mixed with SP in a common pen (GM), SP separately penned, and SP mixed with GP in a common pen (SM), with littermates split among treatments. The GM and SM pigs were penned together after weaning. Individual live weight of all progeny was recorded at birth (birth weight [BWT]), weaning (28 d; weaning weight [WWT]), 10 wk of age (10-wk weight [10WT]), and sale (22-23 wk; sale weight [SWT]). Individual HCW, backfat depth, loin depth, and dressing percentage were measured at slaughter. All postweaning mortalities and medications were recorded. The GP had a lighter BWT ( = 0.032), WWT ( < 0.001), 10WT ( < 0.001), and SWT ( < 0.001) than SP as well as a lower HCW ( < 0.001) and dressing percentage ( = 0.012). Postweaning performance differences were mostly attributable to the lighter WWT of GP compared with that of SP when WWT was fitted as a covariate. The GP had a higher mortality in the immediate postweaning period (weaning to 10 wk of age; = 0.028) and from weaning to sale ( = 0.012) than SP, which was also attributable to lower WWT. The GP exhibited a higher incidence of mortality ( = 0.011) due to respiratory tract infection in the grower-finisher period, despite similar medication rates ( = 0.83). Segregation of GP and SP between pens presented no benefit in terms of growth and survival of both groups while requiring added labor and production considerations and, therefore, is not recommended. This study confirms that GP are lighter than SP, on average, at every stage of life from birth to slaughter and that their performance before weaning is an important determinant for whole-of-life performance.

Thrombomodulin activity and localization.

An overview on the properties, actions and localization of thrombomodulin (TM) in situations of tissue injury and in selected tumors is presented. The localization and activity of TM after injury to vascular endothelium shows that following balloon catheter denudation of the endothelium of the rabbit aorta, the activity and immunohistochemical staining is markedly reduced. The functional and antigenic levels approach the control levels approximately one week after the initial injury. The results suggest that the neointimal smooth muscle cells express TM. This phenotypic plasticity of the neointimal smooth muscle cells may be important in conferring thrombo-resistance to the lumenal lining cells of vessels after injury. Studies are also reviewed on the use of soluble recombinant TM to prevent thrombosis after ligature of vessels in an experimental model. Further characterization on the immunohistochemical distribution of TM in normal tissues and tumors shows that staining with a monoclonal anti TM antibody can be very useful in separating mesotheliomas from pulmonary adenocarcinomas. These studies may lead to insights concerning the role of TM in tissue-injury-repair and tissue differentiation.

Randomized controlled trial to compare sleep and wake in preterm infants less than 32weeks of gestation receiving two different modes of non-invasive respiratory support.

AIM: To determine whether respiratory support via heated humidified high flow nasal cannulae (HHHFNC) results in infants <32weeks gestation spending a greater proportion of time in sleep compared to those receiving nasal continuous positive airway pressure (NCPAP). METHODS: A subgroup of infants enrolled in a randomized controlled trial to compare HHHFNC or NCPAP post-extubation had sleep and wake activity measured by actigraphy for 72hours post-extubation. Activity diaries were completed contemporaneously to record episodes of infant handling. Actigraphy data were downloaded with known periods of handling excluded from the analysis. RESULTS: 28 infants with mean gestation of 28.3weeks (SD 2) and birth weight 1074g (SD 371) were studied. Infants receiving HHHFNC spent a lesser proportion of time in sleep 59.8% (SD 18.5) than those on NCPAP 82.2% (SD 23.8) p=0.004. Infants receiving HHHFNC had a lower sleep efficiency and higher mean activity score than those on NCPAP (p=0.003, p=0.002, respectively). CONCLUSION: Infants receiving HHHFNC had a higher mean activity score and spent less time in sleep than those allocated NCPAP. Further study of sleep wake activity in preterm infants receiving respiratory support is required as this may impact on neurodevelopmental outcomes.

Multiwell 14CO2-capture assay for evaluation of substrate oxidation rates of cells in culture.

14CO2 capture is commonly used to evaluate the cellular oxidation rate of respiratory substrates. A modification of the established 14CO2-capture method was developed that enables the use of cells in adherent culture and easy analysis of multiple samples under different culture conditions. The use of commercially available culture and filter plates designed for use in a multiplate scintillation spectrophotometer enabled substrate oxidation rates to be evaluated for cells in a 24-well plate format without the need to dislodge the cells from the culture substrate as is required in traditional methods. Evaluation of radioactivity captured in potassium hydroxide-saturated filters was accomplished by adding scintillation fluid to the filter plate wells and counting. Alternatively, filters could be removed and placed in vials for evaluation in a conventional scintillation counter. This method was applied to the oxidation of 14C-glutamine by human breast cell lines and demonstrated concentration-dependent linear accumulation of captured counts.

The in vivo performance of 250 internal fixation devices: a follow-up study.

The in vivo performance of 250 retrieved internal fixation plates was evaluated. The corrosion characteristics and metallurgical properties of each implant were assessed and correlated with respective clinical performance. Screw-plate interface corrosion and screw surface corrosion were graded; Rockwell hardness, grain size, thin inclusion content, and heavy inclusion content measurements were made. The devices studied included 169 bone plates, 59 Richards type hip screw-plates and 22 Jewett type hip nail-plates. The devices remained in situ for an average of 26.3 months, with in situ periods ranging from 1 to 192 months. The majority of the plates (50.4%) were removed due to cause-related reasons, while the remaining devices (49.6%) were removed on a routine asymptomatic basis. The primary symptomatic removal reasons consisted of implant related pain, nonunion or malunion, infection, loosening and implant breakage. Upon stereomicroscopic examination, 89% of all plates exhibited some degree of interface crevice corrosion, and 88% of all screws exhibited some degree of surface corrosion. Statistical analysis of corrosion gradings and metallurgical data revealed significant correlations between the two. As was suggested in our previous study of a limited number of implants, this study demonstrates that stricter manufacturing standards for metallurgical properties would serve to enhance corrosion resistance and improve the in vivo performance of stainless steel internal fixation devices. It is also suggested that the routine removal of all internal fixation plates after fracture healing has been achieved would reduce the occurrence of symptomatic complications, such as implant breakage, implant loosening and implant related pain.

Do proficiency test results correlate with the work performance of screeners who screen Papanicolaou smears?

We rescreened Papanicolaou smear slides from 40,245 women, which had been examined by 81 cytology screeners, scored the screeners' work performance, and compared these scores with the results of the screeners' performance on glass slide and computer-based proficiency tests. All diagnoses (i.e., from the proficiency tests, the original slides, and the rescreened slides) were classified in the 4 diagnostic categories specified in the Clinical Laboratory Improvement Amendments. The rescreening scores were standardized to account for different distributions of abnormalities in the proficiency tests and rescreened slides. We compared a standardized score with the proficiency test scores. Of the cases, 91% were categorized as normal, benign, or reactive changes when rescreened, and 98% of these agreed with the original diagnosis. Sixteen percent of low-grade and 15% of high-grade intraepithelial lesions were classified as normal. The rank correlation between the rescreening scores and both proficiency tests was 0.24 using a scoring scheme for cytotechnologists. The correlation between the rescreening and proficiency testing scores indicates that performance on a 10-slide test gives some indication of the true performance of screeners. The computer-based test shows promise as an alternative to the glass slide test but needs further development and validation.

Regulation of glutamine synthetase in human breast carcinoma cells and experimental tumors.

BACKGROUND: Acute deprivation of extracellular glutamine causes up-regulation of glutamine synthetase (GS) expression by a mechanism involving an increase in GS protein stability. This study examines GS expression in a highly glutamine-dependent and tumorigenic human breast cancer cell line, TSE cells, in response to acute and chronic glutamine deprivation in culture and during tumor formation. METHODS: TSE cells were subjected to acute glutamine deprivation, adapted to growth in low glutamine concentrations, and subcutaneously injected into nude mice. GS protein and mRNA levels were assayed by Western and Northern blotting, and intracellular glutamine levels were evaluated by using a colorimetric assay. RESULTS: GS protein levels increased, but GS mRNA levels were unchanged in response to acute glutamine deprivation. Chronic glutamine deprivation in vitro and tumor growth in vivo caused an increase in both GS protein and mRNA levels. Large tumors exhibited lower intracellular glutamine, higher GS protein, and relatively unchanged GS mRNA levels relative to small tumors. CONCLUSIONS: TSE tumors exhibit up-regulation of GS protein and mRNA levels and declines in intracellular glutamine content, suggesting that growth in vivo causes a chronic and progressive glutamine deprivation. Up-regulation of GS expression may contribute to adaptation to a nutrient-poor intratumor environment.

Respiratory syncytial virus infections in children and adults.

Respiratory syncytial virus is the leading cause of hospital admission for lower respiratory tract infection in young children and appears to be responsible for a significant burden of disease in adults, particularly the elderly and the immunocompromised. In this review, we describe the epidemiology, diagnosis and clinical manifestations of infection attributed to this virus. We also consider current therapeutic and prophylactic options and appraise strategies for vaccination that are in clinical trials.

HIV safety guidelines and laboratory training. NIOSH.

At the Centers for Disease Control (CDC), educational activities concerning acquired immunodeficiency syndrome (AIDS) are directed to many target audiences; important among these are health care and public safety workers. Several CDC programs are designed to address the specific education and training needs of these groups. The National Institute for Occupational Safety and Health (NIOSH) has developed a set of occupational safety guidelines directed to fire service personnel, emergency medical technicians, paramedics, and law enforcement and correctional facility personnel. These guidelines provide information on modes of transmission of human immunodeficiency virus (HIV) in the workplace, the risk of transmission, the control of risk, and specific risk-control recommendations. NIOSH also has developed a model curriculum, based on the principles and practices discussed in the guidelines, for use in training workers. The Hospital Infections Program (HIP) at CDC's National Center for Infectious Diseases is responsible for assessing the risk of HIV infection for both health care workers and patients. As part of this effort, HIP has developed guidelines to prevent transmission of HIV and other bloodborne pathogens in health care settings, as well as statements regarding management of occupational exposure to HIV. The Public Health Practice Program Office provides laboratory training to health care workers who are performing HIV- and AIDS-related testing. This training is delivered through the National Laboratory Training Network and through courses given at CDC headquarters in Atlanta. The delivery of laboratory training is supported by the development of training materials and by performance evaluation programs.

Malignant acoustic schwannoma.

An unusual pleomorphic tumor was resected from the cerebellopontine angle of a 40-year-old man with no stigmata of neurofibromatosis. The tumor showed multinucleated giant cells scattered amid smaller, slightly elongated cells. The tumor showed a rudimentary fascicular pattern containing some looser areas but no nuclear palisading. A diagnosis of Schwann cell tumor was made based on ultrastructural findings and on immunoreactivity for S100 protein. Malignancy was suggested by the extreme pleomorphism of the tumor, by the presence of tripolar mitotic figures, and by flow cytometric demonstration of aneuploidy and of a significant proportion of S-phase tetraploid nuclei (9%). Ten months after the first operation, the tumor had regrown to its original size, and was again resected. The histologic and ultrastructural appearances were similar to those of the first specimen, but flow cytometric analysis now showed a double aneuploid population of nuclei and showed 12% of the nuclei in tetraploid S phase. Within 11 months of the second operation, the tumor had regrown to an estimated size of 22 cm3. Four months of radiotherapy subsequently halted tumor growth, but additional lesions appeared in the cervical and high thoracic areas.

Nuchal cord: a definition and a study associating placental location and nuchal cord incidence.

The umbilical cord around the neck of the fetus at the time of birth has been referred to in the literature by many different terms, including the term nuchal cord. A standardized definition of nuchal cord is proposed in order to allow for more accurate study of this problem. A prospective study is undertaken applying this specific definition. The results suggest a statistically significant relationship between nuchal cord incidence and placental location. A relationship between fetal heart rate decelerations and placental location also surfaced.

Dietary lecithin improves dressing percentage and decreases chewiness in the longissimus muscle in finisher gilts.

The influence of dietary lecithin at doses of 0, 4, 20 or 80 g/kg fed to finisher gilts for six weeks prior to slaughter on growth performance, carcass quality and pork quality was investigated. M. longissimus lumborum (loin) was removed from 36 pig carcasses at 24h post-mortem for Warner-Bratzler shear force, compression, collagen content and colour analyses. Dietary lecithin increased dressing percentage (P=0.009). Pork chewiness and collagen content were decreased by dietary lecithin (P<0.05, respectively), suggesting that improved chewiness may be due to decreased collagen content. However, dietary lecithin had no effect on shear force, cohesiveness or hardness (P>0.05, respectively). Dietary lecithin reduced loin muscle L* values and increased a* values (P<0.05, respectively) but no changes on b* values (P=0.56). The data showed that dietary lecithin improved dressing percentage and resulted in less chewy and less pale pork.

Maternal low-dose porcine somatotropin treatment in late gestation increases progeny weight at birth and weaning in sows but not in gilts.

Birth weight positively predicts postnatal growth and performance in pigs and can be increased by sustained maternal porcine ST (pST) treatment from d 25 to 100 of pregnancy (term ∼115 d). The objective of this study was to test whether a shorter period of maternal pST treatment in late pregnancy (d 75 to 100) could also increase birth and weaning weights of progeny under commercial conditions. Gilts (parity 0) and sows (parities 2 and 3) were not injected (controls) or injected daily with pST (gilts: 2.5 mg•d(-1), sows: 4.0 mg•d(-1), both ∼13 to 14 µg•kg(-1)•d(-1)) from d 75 to 100 of pregnancy. Litter size and BW were recorded at birth and weaning, and dams were followed through the subsequent mating and pregnancy. Maternal pST injections from d 75 to 100 increased litter average progeny weight at birth (+96 g, P = 0.034) and weaning (+430 g, P = 0.038) in sows, but had no effect on progeny weight in gilts (each P > 0.5). Maternal pST treatment did not affect numbers of live-born piglets and increased numbers of stillborn piglets in sows only (+0.4 pigs/litter, P = 0.034). Maternal pST treatment did not affect subsequent reproduction of dams. Together with our previous data, these results suggest that sustained increases in maternal pST are required to increase fetal and postnatal growth in gilt progeny, but that increasing maternal pST in late pregnancy may only be an effective strategy to increase fetal and possibly postnatal growth in sow progeny.

Maternal responses to daily maternal porcine somatotropin injections during early-mid pregnancy or early-late pregnancy in sows and gilts.

Piglet neonatal survival and postnatal growth and efficiency are positively related to birth weight. In gilts, daily maternal porcine ST (pST) injections from d 25 to 100 (term approximately 115 d), but not d 25 to 50, of pregnancy increase progeny birth weight. Daily maternal pST injections from d 25 to 50 increase fetal weight at d 50 in gilts and sows. We therefore hypothesized that daily pST injections from d 25 to 100, but not d 25 to 50, of pregnancy would increase birth weight similarly in both parities. Landrace x Large White gilts and sows were uninjected (controls) or were injected daily with pST (gilts: 2.5 mg/d; sows: 4.0 mg/d, each approximately 15 microg of pST/kg per day) from d 25 to 50 or 100 of pregnancy. Litter size and BW were recorded at birth, midlactation, and weaning. Dams were followed through the subsequent mating and pregnancy. Maternal pST injections from d 25 to 100, but not d 25 to 50, increased mean piglet birth weight by 11.6% in sows (P 0.1) the weaning-remating interval, conception rate, or subsequent litter size. Greater pST-induced birth weight increases in sows than in gilts may mean that underlying metabolic or placental mechanisms for pST action are constrained by maternal competition for nutrients in rapidly growing gilts.

When the rules of the game are broken: what proportion of high school sports-related injuries are related to illegal activity?

OBJECTIVES: To compare sport and gender differences in injury rates and proportions of injuries related to illegal activity and to describe the epidemiology of injuries related to illegal activity. DESIGN: Descriptive epidemiology study. SETTING: 100 US high schools. SUBJECTS: Athletes participating in nine sports: boys' football, soccer, basketball, wrestling, and baseball plus girls' soccer, volleyball, basketball, and softball. MAIN OUTCOME MEASURES: Illegal activity-related injuries were analyzed using data from the 2005-06 and 2006-07 National High School Sports-Related Injury Surveillance Study. RESULTS: Nationally, an estimated 98 066 injuries were directly related to an action that was ruled illegal activity by a referee/official or disciplinary committee, giving an injury rate of 0.24 injuries per 1000 athletic competition-exposures. Boys' and girls' soccer had the highest rates of injuries related to illegal activity, and girls' volleyball, girls' softball, and boys' baseball had the lowest. Overall, 6.4% of all high school sports-related injuries were related to illegal activity, with the highest proportion in girls' basketball (14.0%), girls' soccer (11.9%), and boys' soccer (11.4%). A greater proportion of injuries related to illegal activity were to the head/face (32.3%) and were concussions (25.4%) than injuries not related to illegal activity (13.8% (injury proportion ratio 2.35; 95% CI 1.82 to 3.04; p<0.001) and 10.9% (injury proportion ratio 2.35; 95% CI 1.71 to 3.22; p<0.001), respectively). CONCLUSIONS: Illegal activity is an overlooked risk factor for sports-related injury. Reducing illegal activity through enhanced enforcement of sports' rules and targeted education about the dangers of illegal activity for players, coaches, and referees/officials may reduce sports-related injuries.