Skills among young and elderly laypersons during simulated dispatcher assisted CPR and after CPR training.

BACKGROUND: Dispatcher assisted cardiopulmonary resuscitation (DA-CPR) increase the rate of bystander CPR. The aim of the study was to compare the performance of DA-CPR and attainable skills following CPR training between young and elderly laypersons. METHODS: Volunteer laypersons (young: 18-40 years; elderly: > 65 years) participated. Single rescuer CPR was performed in a simulated DA-CPR cardiac arrest scenario and after CPR training. Data were obtained from a manikin and from video recordings. The primary endpoint was chest compression depth. RESULTS: Overall, 56 young (median age: 26, years since last CPR training: 6) and 58 elderly (median age: 72, years since last CPR training: 26.5) participated. Young laypersons performed deeper (mean (SD): 56 (14) mm vs. 39 (19) mm, P < 0.001) and faster (median (25th-75th percentile): 107 (97-112) per min vs. 84 (74-107) per min, P < 0.001) chest compressions compared to elderly. Young laypersons had shorter time to first compression (mean (SD): 71 (11) seconds vs. 104 (38) seconds, P < 0.001) and less hands-off time (median (25th-75th percentile): 0 (0-1) seconds vs. 5 (2-10) seconds, P < 0.001) than elderly. After CPR training chest compressions were performed with a depth (mean (SD): 64 (8) mm vs. 50 (14) mm, P < 0.001) and rate (mean (SD): 111 (11) per min vs. 93 (18) per min, P < 0.001) for young and elderly laypersons respectively. CONCLUSION: Despite long CPR retention time for both groups, elderly laypersons had longer retention time, and performed inadequate DA-CPR compared to young laypersons. Following CPR training the attainable CPR level was of acceptable quality for both young and elderly laypersons.

Hysteresis and scanning behavior of mesoporous molecular sieves.

Sorption hysteresis is a widely studied phenomenon whose predicted behavior is well documented and researched. On the other hand, there is much less known about the region that lies between sorption isotherms, believed to be a metastable region. Scanning curves are a way of understanding the mechanism of hysteresis and a tool for hysteresis model validation. Scanning curves were produced for mesoporous materials: SBA-15 and MCM-41 for N(2) sorption at 77 K and Ar sorption at 87 K. A limited set of different scanning behaviors is identified. Like most hysteresis theories, it was found that a single model for scanning behavior cannot be extended to all materials under the same or different experimental conditions. Two behaviors are consistent with recent theories and simulations; however, several are not. The implications as to the characterization of pore dimensions and structure are discussed.

The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%.

BACKGROUND: The incidence of TNS after spinal anaesthesia is a problem. Especially the use of hyperbaric lidocaine in patients placed in the lithotomy position during surgery has been associated with a high incidence of TNS. The present study was performed to investigate whether TNS is present more frequently in patients undergoing surgery in the supine position with use of hyperbaric lidocaine compared with hyperbaric bupivacaine. METHOD: Seventy patients were included and randomised to receive either hyperbaric lidocaine or hyperbaric bupivacaine. All patients were contacted on the first and third postoperative days by an anaesthesiologist blinded to the local anaesthetic used. The patients were asked about symptoms of TNS, pain not associated with the operation area, and asked to grade the complaints after a verbal analogue score from 0 to 10. RESULTS: We found a total of ten patients who showed signs of TNS. There were nine patients in the lidocaine group (26%) who showed signs of TNS compared to only one patient in the bupivacaine group (3%) (P<0.01). The average score of TNS complaints was 3.5. A total of 13 patients (19%) complained of back pain. There were no significant differences with regard to which local anaesthetic was used. The average score of back pain was 3.3. CONCLUSION: TNS is a significant problem in patients having spinal anaesthesia with hyperbaric lidocaine compared to hyperbaric bupivacaine, both in the supine position. For day-case surgery, TNS would start after dismissal from hospital. The use of hyperbaric lidocaine is therefore questionable, even though these problems are of an order that the majority of patients would still choose spinal anaesthesia for future operations.

Triglyceride-induced diabetes associated with familial lipoprotein lipase deficiency.

Raised plasma triglycerides (TGs) and nonesterified fatty acid (NEFA) concentrations are thought to play a role in the pathogenesis of insulin-resistant diabetes. We report on two sisters with extreme hypertriglyceridemia and overt diabetes, in whom surgical normalization of TGs cured the diabetes. In all of the family members (parents, two affected sisters, ages 18 and 15 years, and an 11-year-old unaffected sister), we measured oral glucose tolerance, insulin sensitivity (by the euglycemic-hyperinsulinemic clamp technique), substrate oxidation (indirect calorimetry), endogenous glucose production (by the [6,6-2H2]glucose technique), and postheparin plasma lipoprotein lipase (LPL) activity. In addition, GC-clamped polymerase chain reaction-amplified DNA from the promoter region and the 10 coding LPL gene exons were screened for nucleotide substitution. Two silent mutations were found in the father's exon 4 (Glu118 Glu) and in the mother's exon 8 (Thr361 Thr), while a nonsense mutation (Ser447 Ter) was detected in the mother's exon 9. Mutations in exons 4 and 8 were inherited by the two affected girls. At 1-2 years after the appearance of hyperchylomicronemia, both sisters developed hyperglycemia with severe insulin resistance. Because medical therapy (including high-dose insulin) failed to reduce plasma TGs or control glycemia, lipid malabsorption was surgically induced by a modified biliopancreatic diversion. Within 3 weeks of surgery, plasma TGs and NEFA and cholesterol levels were drastically lowered. Concurrently, fasting plasma glucose levels fell from 17 to 5 mmol/l (with no therapy), while insulin-stimulated glucose uptake, oxidation, and storage were all markedly improved. Throughout the observation period, plasma TG levels were closely correlated with both plasma glucose and insulin concentrations, as measured during the oral glucose tolerance test. These cases provide evidence that insulin-resistant diabetes can be caused by extremely high levels of TGs.

Purification and 1H NMR spectroscopic characterization of phase II metabolites of tolfenamic acid.

Tolfenamic acid, an anti-inflammatory drug (NSAID), is metabolized in vivo to form several oxidative metabolites which are all conjugated with beta-D-glucuronic acid. In this study, the metabolites of tolfenamic acid were identified by 1H nuclear magnetic resonance (NMR) spectroscopy in urine samples obtained on days 7 to 10 from a human volunteer after oral administration of 200 mg of the drug three times per day (steady-state plasma concentration). The metabolites of tolfenamic acid were initially concentrated by preparative solid phase extraction (PSPE) chromatography, thereby removing the endogenous polar compounds that are present in the urine. The individual metabolites were purified by preparative high performance liquid chromatography (HPLC) and then identified using 1H NMR. Both one- and two-dimensional NMR experiments were performed to identify the phase II metabolites of tolfenamic acid; the study shows the applicability of 1H NMR for the identification of drug metabolites in biological fluids. In addition to NMR analysis, two metabolites were also identified by mass spectrometry (MS). The glucuronides of the following parent compounds, N-(2-methyl-3-chlorophenyl)-anthranilic acid (T), N-(2-hydroxymethyl-3-chlorophenyl)-anthranilic acid (1), N-(2-hydroxymethyl-3-chloro-4-hydroxyphenyl)-anthranilic acid (2), N-(2-formyl-3-chlorophenyl) anthranilic acid (3), N-(2-methyl-3-chloro-4-hydroxyphenyl)-anthranilic acid (4), N-(2-methyl-3-chloro-5-hydroxyphenyl)-anthranilic acid (5), N-(2-carboxy-3-chlorophenyl)-anthranilic acid (6), N-(2-hydroxymethyl-3-chlorophenyl)-4-hydroxy-anthranilic acid (7), N-(2-methyl-3-chlorophenyl)-5-hydroxy-anthranilic acid (8), N-(2-methyl-3-chloro-4-metoxyphenyl)-anthranilic acid (9), N-(2-methyl-3-chlorophenyl)-4-hydroxy-anthranilic acid (10), and N-(2-methyl-4-hydroxyphenyl)-anthranilic acid (11) were identified. The phase II metabolites (5-11) had not previously been identified in urine from humans administered tolfenamic acid. The phase I metabolites of the glucuronides 7, 8, 10, and 11 were identified here for the first time. An HPLC method was developed that simultaneously separates all the phase II metabolites identified as well as some phase I metabolites in urine samples obtained after intake of tolfenamic acid.

Effectiveness of a portable face mask in attenuating exercise-induced asthma.

Recent investigations have demonstrated that exercise-induced asthma (EIA) can be prevented by inspiration of warm, fully humidified air during exercise. We evaluated the success of a surgical face mask, used to retain warm, humidified, expired air, in preventing EIA in ten asthmatic children. subjects underwent six minutes of exercise on a treadmill during two sessions, in one session breathing room air and in another wearing a mask covering the nose and mouth. On the control day, average group forced expiratory volume in 1 s (FEV1) and maximal midexpiratory flow rate (MMEF) decreased from the preexercise baseline value to 66% and 47% of baseline, respectively, at six minutes; on the mask day, FEV1 and MMEF were 91% and 82% of the baseline values (increased in all subjects). A simple face mask may be an inexpensive, nonpharmacologic alternative for alleviation of EIA.

VO2max during horizontal and inclined treadmill running.

The VO2max response of 12 well-trained and highly motivated college males was measured using two treadmill protocols: horizontal (H) and inclined (I). The duration of each test averaged 10 min. In the H test the treadmill bed was horizontal with the running rate held constant for the first 6 min, after which time it was increased at 1-min intervals to near maximal subject running speed, according to the HR response, until exhaustion. The I method simulated the protocol of Costill and Fox, with the treadmill speed at about 80-90% of mean maximal running rate established from 12- and 15-min track runs. The treadmill bed was held horizontal during the first 4 min, after which time it was elevated to 4% and elevated 2% each 2 min thereafter until exhaustion. No significant differences were found in VO2max, 4.267 1/min (I), and 4.192 1/min (H), average max HR, 190.4/MIN (I), and 188.9/min (H); respiratory rate, 56.4/min (I), and 62.0/min (H); and VEBTPS, 145.2 1/min (I), and 143.3 1/min (H). It was concluded that the intensities of both treadmill methods, H and I, were sufficient to produce a nonsignificant difference in maximal VO2 values with the type subjects employed.

Problems of adjustment reported among a group of heroin addicts.

Many reports in the literature concerning the heroin addict and his addiction have been related to psychological tests and the personality and behavior among addicts. However, studies have not cited his adjustment problems. Forty-seven narcotic addicts were surveyed to determine their adjustment difficulties by an administration of the Mooney Problem Checklist. The results indicate that the most difficult areas of adjustment were related to personality, self-improvement, the home and family, and occupation. It was concluded that among these participating narcotic addicts, four areas were noted as frequent problems while five additional areas were reported as less of an adjustment difficulty.