A comparison of the characteristics of profiles produced with the AMPFlSTR SGM Plus multiplex system for both standard and low copy number (LCN) STR DNA analysis.

DNA STR profiles have been generated from 1 ng and low copy number (LCN) templates using 28 and 34 cycles of amplification, respectively. Characteristics which facilitate the interpretation of profiles, such as heterozygous balance, allelic dropout and stutter proportions have been quantified. We demonstrate that a reduction in DNA template coupled with an increase in amplification cycle number produces an increased rate of allelic dropout out which can be correlated to the peak areas of those alleles observed. In addition, the LCN conditions increase the degree of peak area asymmetry observed from heterozygotes and the size range of stutters. Analysis of the data allows us to develop sets of guidelines appropriate for interpreting both single and mixed DNA profiles.

The validation of a nursing nutritional assessment tool for use on acute elderly wards.

BACKGROUND: Elderly people are at great risk of poor nutritional status. Identifying those at nutritional risk is complex owing to its multifactorial nature and highlights the need for an easily administered nutritional screening tool. AIM: To test the robustness of a tool used to identify those patients who require further dietetic assessment. METHOD: The tool was tested on an 'acute elderly' ward to assess its statistical robustness, i.e. test-retest reliability, inter-rater reliability, internal consistency and factor structure, concurrent and construct validity. The research was carried out by a dietitian and two nurses on an overall sample of 185 consecutive admissions. RESULTS: Test-retest results reflect that the tool is capable of yielding consistent assessments over time. Inter-rater reliability results revealed that when comparisons of agreement between nurses and dietitians were examined there was consistent disagreement. Internal consistency was found to be low but the rotated factor analysis suggested a relationship between the items in the tool. Concurrent validity was exhibited with body mass index, albumin and American Nutrition Risk Index only. Construct validity was not sufficiently exhibited with any of the measures used. CONCLUSION: The tool has not demonstrated reliability as determined by the statistical measures and hence validity at this stage. Issues which need to be addressed to allow this tool to be used appropriately are discussed.

Validation of the AMPFlSTR SGM plus system for use in forensic casework.

The AMPFlSTR((R)) SGM Plus system is a commercially available STR multiplex produced by Applied Biosystems, a division of Perkin Elmer, Foster City, California, USA that supersedes SGM. The multiplex contains the six SGM loci, amelogenin and four additional loci. These additional loci are D3S1358, D19S433, D16S539 and D2S1338. Consequently, the match probability is significantly improved (conservatively quoted as 1 in 10(9) for reporting a full profile match). The system was subjected to validation. For example, ageing and degradation studies demonstrated semen stains to be the most stable evidence type, whereas buccal scrapes were the least stable. An apparent rise in the sensitivity increases the chance of obtaining successful results from the more difficult samples submitted for analysis. Two of the new loci (D3S1358 and D19S433) are low molecular weight (between 100 and 150 base pairs); this improved the success rates of the degraded samples where high molecular weight loci may drop out. Of 26 non-primates tested, four gave results that appeared as single peaks and were unlikely to cause interpretation problems. None of the 19 micro-organisms tested gave discernible results. Extensive casework and simulated casework studies demonstrated that SGM and SGM plus results were comparable. There was one example of a null allele (primer binding site mutation) recorded at the HUMFIBRA locus (in both systems). However, a concordance study of 1000 samples using both SGM and SGM plus did not demonstrate any differences in typing.

A nutritional assessment tool for older patients.

Older people are at increased risk of poor nutritional status. Nutritional support can improve the outcome of medical and surgical treatments and reduce length of hospital stay. Assessment is complex owing to the multifactorial nature of nutritional risk. An easily administered nutritional screening tool can be incorporated into the nursing assessment of older patients.

Quantitation of insulin-like growth factor-I binding to highly purified human erythroid colony-forming units.

A method has been developed by which erythroid colony-forming units (CFU-E) may be obtained from human blood in sufficient number and purity for quantitative studies of growth factor binding. Studies in serum-free medium have shown that CFU-E require the addition of only two growth factors, erythropoietin (EP) and insulin-like growth factor-I (IGF-I), for growth and differentiation. The IGF-I may be replaced by higher (100-fold) concentrations of insulin. Incubation of CFU-E with 125I recombinant human IGF-I (rhIGF-I) at 4 degrees C has demonstrated specific binding that is directly proportional to the cell concentration. Competition with unlabeled rhIGF-I markedly decreased binding, whereas other growth factors such as granulocyte-monocyte colony-stimulating factor (GM-CSF), interleukin 3 (IL-3), and epidermal growth factor (EGF) had no significant effect on the binding of [125I]rhIGF-I. The binding was saturable at an [125I]rhIGF-I concentration of 10 ng/ml (1.2 nM). Scatchard analysis revealed two classes of IGF-I receptors present on the CFU-E cell surface: a low-affinity class of 549 receptors with Kd = 0.44 nM and a high-affinity class of 341 receptors with Kd = 0.04 nM.

Non-cardiogenic pulmonary edema after pericardial drainage for cardiac tamponade.

We report a patient who developed adult respiratory distress syndrome following relief of pericardial tamponade. Because of increasing recognition of pulmonary edema in this situation, we recommend gradual removal of pericardial fluid with hemodynamic monitoring to limit the massive fluid shifts which appear to herald this dire complication.

Effects of exercise at high altitudes on young adults.

Outward Bound programs are carried out throughout the world, and many of these courses occur at altitudes above 3000 m (10,000 ft). As more knowledge is accumulated about health problems at high altitudes, exercise has been implicated as a factor contributing to acute mountain sickness in susceptible individuals. Thus, exercise conditioning programs occurring at high altitudes have come under scrutiny. Twenty-eight young men and women were enrolled in an Outward Bound course at an altitude over 3000 m for a 21-day period. Twelve of the 28 individuals developed shortness of breath, cough, or both by the third day of the course. Of these 12, seven had pulmonary function abnormalities: three having evidence of large airway involvement and four having findings of small airway involvement. The symptoms were not significant enough to interfere with acclimatization and the muscular conditioning aspects of the program. Although at altitudes between 3000 m and 4300 m, pulmonary function abnormalities of acute mountain sickness develop in a significant number of participants, the abnormalities were not significant enough to prevent persons from completing the course or achieving marked improvements in fitness measurements.

Legionella and mycoplasma pneumonia--a community hospital experience with atypical pneumonias.

The clinician should be alert to the possibility of Legionella pneumonia in the community hospital setting. Importantly, degree of suspicion, that is, familiarity with extrapulmonary clinical and laboratory features of the typical pneumonias, nearly always leads to a correct presumptive diagnosis that may later be confirmed by serologic testing. Serologic testing has confirmed only a minority of cases. Since early empiric therapy is critical to survival in many of these patients, knowing how to arrive at a presumptive diagnosis based upon the clinical clue present or absent is essential in the community hospital setting.

Foreign body aspiration.

Aspiration of foreign objects remains a major cause of airway injury in children. In this article, diagnosis and treatment are discussed and prevention is urged.

Emergency treatment of foreign-body obstruction of the upper airway in children.

Recently, the Committee of Accident and Poison Prevention of the American Academy of Pediatrics presented its recommendations regarding the emergency management of the choking child. Renewed interest was stimulated in the controversy regarding whether back blows, abdominal thrusts, or chest thrusts should be used in the initial treatment of foreign-body obstruction of the upper airway. Two cases exemplifying problems in patient management are presented as a basis of focusing on the current controversy. Review of the clinical and experimental data suggests that back blows, followed by either chest or abdominal thrusts, are a reasonable approach to emergency airway obstruction, but that this recommendation is based on limited evidence.

Serial changes in pulmonary functions in children hospitalized with cystic fibrosis.

Pulmonary functions were serially measured in 17 children hospitalized with cystic fibrosis (CF) to determine how much and when pulmonary functions improved during 14 days of inpatient treatment. Absolute lung volumes and forced expiratory flows were recorded every other day while patients received chest physiotherapy, antibiotics, and bronchodilators. Vital capacity first improved after the fifth hospital day coincidentally with a reduction in residual volume and an increase in peak expiratory flow rate. Significant improvements in other pulmonary functions developed later in the hospitalization. Improvement in most pulmonary functions continued throughout the hospitalization and was maintained 2 wk after discharge. Improvement was less and uniformly developed later in those children with severe lung disease on admission (NIH score less than 50) compared with those with moderate respiratory involvement (NIH score greater than 50). Pulmonary function measurements may prove useful in determining the optimal duration of treatment for patients who are hospitalized with CF.

A dual approach to tracheobronchial foreign bodies in children.

From 1974 to 1980, 57 consecutive cases of children with tracheobronchial foreign bodies were treated by a new protocol in which peripherally located foreign bodies were treated nonoperatively and centrally located foreign bodies were removed bronchoscopically. Bronchoscopic removal was ultimately successful in all of the 29 children in whom the foreign body was located in the trachea or mainstem bronchus. There were eight minor complications, and in three instances it was necessary to repeat the bronchoscopy for retained fragments. In the other 28 children the foreign body was located in the segmental or lobar bronchi, and initial treatment consisted of a program employing inhalation bronchodilators, pulmonary drainage, and thoracic percussion. Treatment was successful (foreign body coughed out) in 18 patients (64%). Of the other 10 children subsequent bronchoscopy was successful in eight and failed in two patients. Of the latter patients, one required bronchotomy, and the other coughed out the foreign body. There were no deaths, major complications, or permanent pulmonary damage in either treatment series.

Selenium: childhood poisoning and cystic fibrosis.

Two cases of selenium ingestion in children are described; one child with severe cystic fibrosis died. Both children had cystic fibrosis and both had low serum chloride in association with selenium usage. Neither child was exposed to excessive heat or cold weather, factors known to salt-deplete children were cystic fibrosis, although one child was dehydrated during a summer month on initial presentation. One child had protein-calorie malnutrition, a condition known to enhance selenium toxicity in animals. We conclude that selenium is a potential hazard in its use as a health food fad for children with cystic fibrosis and in overdose ingestions. Thus selenium supplementation may have contributed to the morbidity and mortality reported here.

Intravenous aminophylline in patients with cystic fibrosis. Pharmacokinetics and effect on pulmonary function.

Intravenous aminophylline was administered to ten patients with cystic fibrosis (CF) to determine if the medication would improve pulmonary function and to study theophylline pharmacokinetics. Intravenous normal saline was given on another day as a control. Thoracic gas volume and airway resistance, measured in a volume displacement body plethysmograph, and maximal expiratory flow-volume curves were performed before and after each infusion. No significant improvement was noted in pulmonary function after normal saline infusion. Following aminophylline infusion. Following aminophylline infusion, significant improvement in thoracic gas volume, residual volume, specific airway conductance, and maximal expiratory flow at 60% of total lung capacity was noted. The pharmacokinetic analysis revealed a mean half-life of 4.7 hours, a total clearance of 91 mL/hr/kg, and a volume of distribution of 574 mL/kg. Intravenous aminophylline can acutely decrease airway obstruction in children with CF.

Re-evaluation of birth weights at high altitude. Study of babies born to mothers living at an altitude of 3,100 meters.

Babies born at altitudes above 2,700 meters have been reported to be below normal birth weight and small for gestational age (SGA). In a study of a specific community (Leadville, Colorado, altitude 3,100 meters) over a period of 14 months (ending November, 1978), 215 newborn infants were found to be appropriate for gestational age (AGA), with the entire group having a mean birth weight (3.16 kilograms) similar to that of newborn infants in Denver, Colorado (3.12 kilograms). This study from a community with a stable population indicates that babies born at high altitude are AGA. The increased morbidity which does occur for these babies is not due to SGA factors.

Endotracheal foreign bodies. Difficulties in diagnosis.

The diagnosis of foreign body aspiration into the lower airway depends primarily on the radiographic demonstration of partial bronchial obstruction causing localized air trapping or atelectasis, present in 95 per cent of the cases. Endotracheal foreign bodies may often be visualized directly on high kilovoltage radiographs of the airway of the airway or by fluoroscopy. In three of the four cases presented in this report, radiologic evaluation was normal, but endotracheal foreign bodies were subsequently demonstrated endoscopically. Foreign objects may remain in the trachea for prolonged periods of time, causing persistent coughing, wheezing, or stridor. When there is a clear history or strong suspicion of foreign body aspiration in a patient with persistent symptoms, bronchoscopy should be used for diagnosis and treatment.

Effects of hypoxia on respiratory control in neonates at high altitude.

The respiratory responses to acute hypoxia were investigated in 21 newborn infants in Leadville, CO. Time-related changes in pulmonary ventilation (VE) described four distinct phases to the hypoxic response characterized by an abrupt initial decrease (phase I), a transient subsequent increase (phase II) and decrease (phase III), and a further transient decrease upon termination of the hypoxic challenge (phase IV). Based on the degree of respiratory stimulation during phase II, the subjects were divided into two groups, "responders" and "nonresponders." In both groups in VE were attributed to variation in tidal volume (VT), inspiratory duration (TI), and breath duration being little affected. The latter indicated an absence of vagal volume-related modulation of respiratory pattern. In all subjects, a fixed linear function described the relationship between the mean inspiratory flows at 0.3 s after inspiratory onset (i.e., V0.3/0.3) ant at end inspiration (i.e., VT/TI). Thus, changes in respiratory output with hypoxia are attributed to variations in both the "gain" and "shape" of the inspiratory drive.