Comparing ovarian expression of sperm acrosome associated 3 protein in young and adult queens.

The purpose of this research was to quantify sperm acrosome associated 3 protein expression in the ovaries of young (3.0 ± 0.9 months, n = 11) and adult (10.4 ± 2.8 months, n = 11) queens. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded feline ovarian sections. Ovaries were obtained following routine ovariohysterectomy of queens. Cellular expression of sperm acrosome associated 3 protein was measured in primordial, primary, secondary, and tertiary follicles using an image-analysis software's red, green, and blue stack and manual thresholding functions. The oocyte nucleus, ooplasm, granulosa cells, and theca cells were outlined using the freehand selection tool and mean grey value was recorded. Results from each cellular location were compared between age groups using a Student's t-test and between follicle stages using an analysis of variance. Compared to adult queens, younger queens had significantly greater sperm acrosome associated 3 protein expression in granulosa cells of primary, secondary, and tertiary follicles. Also, theca cells of secondary and tertiary follicles had significantly greater sperm acrosome associated 3 protein expression in younger queens compared to adult queens. The oocyte nucleus of primordial, primary, and secondary follicles had significantly greater sperm acrosome associated 3 protein expression in younger queens compared to adult queens. However, sperm acrosome associated 3 protein expression within the ooplasm did not differ significantly between age groups of any follicle type. More research is needed to determine what role sperm acrosome associated 3 protein may play in female fertility in animals as well as what mechanisms regulate ovarian sperm acrosome associated 3 protein expression over time.

Emergency airway and ventilator procedures for community based home care staff validation of an educational program.

BACKGROUND: Children discharged home with tracheostomy and chronic mechanical ventilator support are at high risk for complications and adverse events. Private duty nursing and home respiratory care services are a critical support necessary for successful discharge. The literature suggests that there are opportunities for home care staff (HCS) to improve upon the skills necessary to assess and intervene in an emergency thereby increasing the likelihood of improving long-term outcomes. METHODS: HCS (RN, LPN, RRT) participated in a 4-h session comprised of lecture and simulation. Lecture content focused on tracheostomy safety, operation of the Trilogy and LTV home ventilators, and review of their common alarms. Simulation included two scenarios simulating tracheostomy decannulation and mucous plugging events. Participant comfort with tracheostomy and ventilator management skills were measured on a five item self-assessment tool and clinical knowledge was measured using an 11 item multiple choice skills test, both of which were completed before and after the session. We tested to see if there was a change in test scores from pre- to post-intervention. RESULTS: Fifty-four HCS participated in the program and provided complete data sets. The vast majority (68%) were registered nurses, followed by licensed practical nurses (19%) and respiratory therapists (12%). Participant self-reported comfort with emergency skills prior to intervention was 3.2/5 which increased to 4.1/5 after intervention (P > 0.0001). Average test score prior to intervention was 62%, post intervention score increased to 82% which represented significant improvement (P > 0.0001). DISCUSSION: HCS are generally unprepared to intervene in an acute airway or ventilator emergency. This short, manageable program provided education that resulted in a significant improvement in both skill level and confidence.

Tracheotomy in very low birth weight neonates: indications and outcomes.

OBJECTIVE/HYPOTHESIS: To review incidence of, indications for, and outcomes of tracheotomy in very low birth weight (VLBW) infants. STUDY DESIGN: Retrospective review in tertiary care hospital. METHODS: Eighteen VLBW (<1,500 g) infants with bronchopulmonary dysplasia undergoing tracheotomy in the neonatal intensive care unit between October 1997 and June 2002 were studied. Controls consisted of 36 VLBW infants undergoing intubation without tracheotomy, two per study infant, matched by gestational age and weight. Outcome measures included duration and number of intubation events, time to decannulation, complications, comorbidities, length of stay, and speech, language, and swallowing measures. RESULTS: Infants undergoing tracheotomy had an average duration of intubation of 128.8 days with a median number of 11.5 intubation events, both significantly greater than those of controls. Percentage of those with laryngotracheal stenosis was 44% of study infants had laryngotracheal stenosis compared to 1.6% in all intubated VLBW infants. The tracheotomy group had a significantly higher incidence of gastroesophageal reflux, pulmonary hypertension, and gastrostomy tube placement. The overall tracheotomy-related complication rate was 38.9%. Three were lost to follow-up, and five deaths occurred, two possibly tracheotomy-related. Six of ten were decannulated by an average time of 3.8 years, two of six after laryngotracheal reconstruction. Four of ten remained cannulated for a variety of reasons. Disorders of speech, language, and swallowing were common. CONCLUSIONS: When considering tracheotomy in VLBW infants, the total number of intubation events should be monitored as well as the total duration of intubation. The relatively high incidence of laryngotracheal stenosis argues for earlier endoscopy and possibly earlier tracheotomy in infants with developing stenoses.

Diagnosis and treatment of the child with a draining ear.

Treating a child with a draining ear is a common occurrence in the pediatric primary office. The symptoms of otorrhea are broad, and a multitude of factors must be considered in arriving at a diagnosis. The assessment begins with a thorough history of the frequency, duration, and characteristics of the drainage. Physical examination of the affected ear requires cleansing of the external auditory canal before the tympanic membrane can be accurately assessed. The ear must be adequately visualized for accurate diagnosis and treatment. Differential diagnoses include acute suppurative otitis media, otitis externa, granuloma, and bullous myringitis. The acutely draining ear is frequently an uncomplicated suppurative event that will respond well to a regimen of aural hygiene and topical therapy. Patients with a chronically draining ear should be referred to an otolaryngologist for further diagnostics and aggressive therapy. Children with tympanostomy tubes are especially at high risk for suppurative complications. Avoiding the introduction of water into the ear, protecting the ear from water, and prophylactic topical treatment are options that have been suggested for prevention of otorrhea.